Transforaminal Lumbar Interbody Fusion: Comparison between Open and Mini-Open Approaches with Two Years Follow-Up
ABSTRACT Background Transforaminal lumbar interbody fusion (TLIF) is an efficient technique which can achieve a fusion rate of up to 90%. Minimally invasive approaches have become increasingly popular because they appear to minimize iatrogenic soft tissue and muscle injury. As minimally invasive TLIF gains popularity, its effectiveness compared with open TLIF has yet to be established. Objective A retrospective study was performed with the aim to compare long-term outcomes of patients who underwent mini-open TLIF with those who underwent open TLIF. Methods This is a retrospective review of prospectively collected data. Between 2005 and 2008, 100 patients underwent TLIF for low-grade spondylolisthesis or degenerative disc disease; 60 underwent open TLIF and 40 underwent mini-open TLIF. The mean age in each group was 48 years, and there were no statistically significant differences between the groups. Data were collected perioperatively. Pain and functional disability were measured using visual analogue scale (VAS) and Oswestry disability index (ODI) at 3 months, 6 months, 1 year, and 2 years. In addition, the fusion was evaluated at 1 year on a computerized tomography (CT) scan. Results The mean VAS improved from 7.3 to 3.8 for back pain and from 7 to 2.7 for leg pain and the ODI decreased from 60 to 30% at 2 years postoperatively. The fusion rate at 1 year was 98%. There were no statistical differences for the clinical and radiological outcomes between the groups. The mean operative time was 186 minutes in the open group and 170 minutes in the mini-open group (p < 0.05) and the mean blood loss was 486 mL in the open group and 148 mL in the mini-open group (p < 0.01). Conclusion The mini-open TLIF for symptomatic low-grade spondylolisthesis and degenerative disc disease is an effective option that achieves the same clinical and radiological outcomes at a minimum 2-year follow-up and reduces perioperative morbidity.
SourceAvailable from: Prashanth J Rao[Show abstract] [Hide abstract]
ABSTRACT: Purpose: While open TLIF (O-TLIF) remains the mainstay approach, minimally invasive TLIF (MI-TLIF) may offer potential advantages of reduced trauma to paraspinal muscles, minimized perioperative blood loss, quicker recovery and reduced risk of infection at surgical sites. This meta-analysis was conducted to provide an updated assessment of the relative benefits and risks of MI-TLIF versus O-TLIF. Methods: Electronic searches were performed using six databases from their inception to December 2014. Relevant studies comparing MI-TLIF and O-TLIF were included. Data were extracted and analyzed according to predefined clinical endpoints. Results: There was no significant difference in operation time noted between MI-TLIF and O-TLIF cohorts. The median intraoperative blood loss for MI-TLIF was significantly lower than O-TLIF (median: 177 vs 461 mL; (weighted mean difference) WMD, -256.23; 95% CI, -351.35,-161.1; P<0.00001). Infection rates were significantly lower in the minimally invasive cohort (1.2% vs 4.6%; relative risk (RR), 0.27; 95%, 0.14, 0.53; I2=0%; P=0.0001). VAS back pain scores were significantly lower in the MI-TLIF group compared to O-TLIF (WMD, -0.41; 95% CI, -0.76, -0.06; I2=96%; P<0.00001). Postoperative ODI scores were also significantly lower in the minimally invasive cohort (WMD, -2.21; 95% CI, -4.26, -0.15; I2=93%; P=0.04). Conclusions: In summary, the present systematic review and meta-analysis demonstrated that MI-TLIF appears to be a safe and efficacious approach compared to O-TLIF. MI-TLIF is associated with lower blood loss and infection rates in patients, albeit at the risk of higher radiation exposure for the surgical team. The long-term relative merits require further validation in prospective, randomized studies.European Spine Journal 03/2015; DOI:10.1007/s00586-015-3903-4 · 2.47 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Hydroxyapatite (HA) is commonly used as bone substitute in clinical practices. However, only few studies have compared the relationship between the mixture ratio of bone graft in the actual clinical field and fusion rate according to bone graft volume. The study aimed to analyze the fusion rate according to the mixture ratio and the amount of bone graft in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).European Journal of Orthopaedic Surgery & Traumatology 09/2014; DOI:10.1007/s00590-014-1529-6 · 0.18 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Adjacent segment disease (ASD) is a potential long-term risk after lumbar fusion. Its incidence has been evaluated in anterior and posterior lumbar interbody fusions, but few studies have focused on transforaminal lumbar interbody fusion (TLIF). Relative risk of ASD with open or minimally invasive (MI) TLIF is poorly understood. To report our experience with risk for ASD in patients receiving TLIF and test its association with surgical approach, we performed a retrospective cohort study based on medical record review at a single institution. Eligible patients were ⩾18years old at operation, underwent single-level TLIF during the period 2007-2008, and had at least 6months postoperative follow-up. Patients were categorized by surgical approach (open versus MI). Primary outcome of interest was development of symptomatic ASD, defined by (1) new back and/or leg pain, (2) imaging findings adjacent to original surgical level, and (3) decision to treat. A total of 68 patients (16 open, 52 MI) were included in the analysis. Groups had similar baseline characteristics, except the open group tended to be older (p=0.04). Seven (10%) patients developed ASD. Mean patient age was 62years and three were male. Three underwent open and four underwent MI TLIF. Risk of ASD did not differ significantly by surgical approach. The MI group showed a trend toward decreased risk of ASD compared to the open group, although it was not statistically significant. This suggests MI TLIF may be associated with decreased long-term morbidity compared to the open approach. Large prospective studies are needed to confirm these findings.Journal of Clinical Neuroscience 05/2014; 21(10). DOI:10.1016/j.jocn.2014.03.010 · 1.32 Impact Factor