Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Provides Sustained Improvements in Clinical and Radiological Outcomes up to 5 Years Postoperatively in Patients with Neurogenic Symptoms Secondary to Spondylolisthesis.
10.4184/asj.2017.11.2.204
- Author:
Hamid Rahmatullah BIN ABD RAZAK
1
;
Priyesh DHOKE
;
Kae Sian TAY
;
William YEO
;
Wai Mun YUE
Author Information
1. Department of Orthopaedic Surgery, Singapore General Hospital, Singapore. yuewm@singnet.com.sg
- Publication Type:Original Article
- Keywords:
Lumbar spine;
Spondylolisthesis, minimally invasive surgery;
Transforaminal lumbar interbody fusion;
Minimal clinically important difference
- MeSH:
Back Pain;
Body Mass Index;
Female;
Follow-Up Studies;
Hospitalization;
Humans;
Leg;
Morphine;
Operative Time;
Prospective Studies;
Retrospective Studies;
Spondylolisthesis*;
Visual Analog Scale;
Walking
- From:Asian Spine Journal
2017;11(2):204-212
- CountryRepublic of Korea
- Language:English
-
Abstract:
STUDY DESIGN: Retrospective review of prospective registry data. PURPOSE: To determine 5-year clinical and radiological outcomes of single-level instrumented minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients with neurogenic symptoms secondary to spondylolisthesis. OVERVIEW OF LITERATURE: MIS-TLIF and open approaches have been shown to yield comparable outcomes. This is the first study to assess MIS-TLIF outcomes using the minimal clinically important difference (MCID) criterion. METHODS: The outcomes of 56 patients treated by a single surgeon, including the Oswestry disability index (ODI), neurogenic symptom score, short-form 36 questionnaire (SF-36), and visual analog scale (VAS) scores for back pain (BP), and leg pain (LP), were collected prospectively for up to 5 years postoperatively. Radiological outcomes included adjacent segment degeneration, fusion, cage subsidence, and screw loosening rates. RESULTS: Our patients were predominantly female (71.4%) and had a mean age of 53.7±11.3 years and mean body mass index of 25.7±3.7 kg/m². The mean operative time, blood loss, time to ambulation, and hospitalization were 167±49 minutes, 126±107 mL, 1.2±0.4 days, and 2.8±1.1 days, respectively. The mean fluoroscopic time was 58.4±33 seconds, and the mean postoperative intravenous morphine dose was 8±2 mg. Regarding outcomes, postoperative scores improved relative to preoperative scores, and this was sustained across various time points for up to 5 years (p<0.001). Improvements in ODI, SF-36, VAS-BP, and VAS-LP all met the MCID criterion. Notably, 5.4% of our patients developed clinically significant adjacent segment disease during follow-up, and 7 minor complications were reported. CONCLUSIONS: Single-level instrumented MIS-TLIF is suitable for patients with neurogenic symptoms secondary to lumbar spondylolisthesis and is associated with an acceptable complication rate. Both clinical and radiological outcomes were sustained up to 5 years postoperatively, with many patients achieving an MCID.
