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Minimally invasive versus open transforaminal lumbar interbody fusion for grade I lumbar spondylolisthesis: 5-year follow-up from the prospective multicenter Quality Outcomes Database registry.
Chan, Andrew K; Bydon, Mohamad; Bisson, Erica F; Glassman, Steven D; Foley, Kevin T; Shaffrey, Christopher I; Potts, Eric A; Shaffrey, Mark E; Coric, Domagoj; Knightly, John J; Park, Paul; Wang, Michael Y; Fu, Kai-Ming; Slotkin, Jonathan R; Asher, Anthony L; Virk, Michael S; Michalopoulos, Giorgos D; Guan, Jian; Haid, Regis W; Agarwal, Nitin; Park, Christine; Chou, Dean; Mummaneni, Praveen V.
Affiliation
  • Chan AK; 1Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York.
  • Bydon M; 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
  • Bisson EF; 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah.
  • Glassman SD; 4Orthopedic Surgery, Norton Leatherman Spine Center, Louisville, Kentucky.
  • Foley KT; 5Department of Neurological Surgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee.
  • Shaffrey CI; 6Departments of Neurosurgery and Orthopedic Surgery, Duke University, Durham, North Carolina.
  • Potts EA; 7Neurosurgery, Goodman Campbell Brain and Spine, Indianapolis, Indianapolis.
  • Shaffrey ME; 8Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.
  • Coric D; 9Neurosurgery, Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
  • Knightly JJ; 10Neurosurgery, Atlantic Neurosurgical Specialists, Morristown, New Jersey.
  • Park P; 5Department of Neurological Surgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee.
  • Wang MY; 11Department of Neurological Surgery, University of Miami, Florida.
  • Fu KM; 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York.
  • Slotkin JR; 13Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania.
  • Asher AL; 9Neurosurgery, Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
  • Virk MS; 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York.
  • Michalopoulos GD; 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
  • Guan J; 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah.
  • Haid RW; 14Neurosurgery, Atlanta Brain and Spine Care, Atlanta, Georgia.
  • Agarwal N; 15Department of Neurological Surgery, University of California, San Francisco, California; and.
  • Park C; 16Duke University School of Medicine, Durham, North Carolina.
  • Chou D; 1Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York.
  • Mummaneni PV; 15Department of Neurological Surgery, University of California, San Francisco, California; and.
Neurosurg Focus ; 54(1): E2, 2023 01.
Article in En | MEDLINE | ID: mdl-36587409
ABSTRACT

OBJECTIVE:

Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has been used to treat degenerative lumbar spondylolisthesis and is associated with expedited recovery, reduced operative blood loss, and shorter hospitalizations compared to those with traditional open TLIF. However, the impact of MI-TLIF on long-term patient-reported outcomes (PROs) is less clear. Here, the authors compare the outcomes of MI-TLIF to those of traditional open TLIF for grade I degenerative lumbar spondylolisthesis at 60 months postoperatively.

METHODS:

The authors utilized the prospective Quality Outcomes Database registry and queried for patients with grade I degenerative lumbar spondylolisthesis who had undergone single-segment surgery via an MI or open TLIF method. PROs were compared 60 months postoperatively. The primary outcome was the Oswestry Disability Index (ODI). The secondary outcomes included the numeric rating scale (NRS) for back pain (NRS-BP), NRS for leg pain (NRS-LP), EQ-5D, North American Spine Society (NASS) satisfaction, and cumulative reoperation rate. Multivariable models were constructed to assess the impact of MI-TLIF on PROs, adjusting for variables reaching p < 0.20 on univariable analyses and respective baseline PRO values.

RESULTS:

The study included 297 patients, 72 (24.2%) of whom had undergone MI-TLIF and 225 (75.8%) of whom had undergone open TLIF. The 60-month follow-up rates were similar for the two cohorts (86.1% vs 75.6%, respectively; p = 0.06). Patients did not differ significantly at baseline for ODI, NRS-BP, NRS-LP, or EQ-5D (p > 0.05 for all). Perioperatively, MI-TLIF was associated with less blood loss (108.8 ± 85.6 vs 299.6 ± 242.2 ml, p < 0.001) and longer operations (228.2 ± 111.5 vs 189.6 ± 66.5 minutes, p < 0.001) but had similar lengths of hospitalizations (MI-TLIF 2.9 ± 1.8 vs open TLIF 3.3 ± 1.6 days, p = 0.08). Discharge disposition to home or home health was similar (MI-TLIF 93.1% vs open TLIF 91.1%, p = 0.60). Both cohorts improved significantly from baseline for the 60-month ODI, NRS-BP, NRS-LP, and EQ-5D (p < 0.001 for all comparisons). In adjusted analyses, MI-TLIF, compared to open TLIF, was associated with similar 60-month ODI, ODI change, odds of reaching ODI minimum clinically important difference, NRS-BP, NRS-BP change, NRS-LP, NRS-LP change, EQ-5D, EQ-5D change, and NASS satisfaction (adjusted p > 0.05 for all). The 60-month reoperation rates did not differ significantly (MI-TLIF 5.6% vs open TLIF 11.6%, p = 0.14).

CONCLUSIONS:

For symptomatic, single-level grade I degenerative lumbar spondylolisthesis, MI-TLIF was associated with decreased blood loss perioperatively, but there was no difference in 60-month outcomes for disability, back pain, leg pain, quality of life, or satisfaction between MI and open TLIF. There was no difference in cumulative reoperation rates between the two procedures. These results suggest that in appropriately selected patients, either procedure may be employed depending on patient and surgeon preferences.
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Full text: 1 Database: MEDLINE Main subject: Spinal Fusion / Spondylolisthesis Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Year: 2023 Type: Article

Full text: 1 Database: MEDLINE Main subject: Spinal Fusion / Spondylolisthesis Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Year: 2023 Type: Article