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 (original) (raw)
Related papers
Journal of Orthopaedics, 2018
Introduction: Lumbar spondylolisthesis is a common cause of morbidity in middle aged individuals. Spinal fusion with instrumentation has become the gold standard for lumbar segmental instability. Studies which correlate the improvement in radiology postoperatively with functional outcome show contrasting reports. This study is aimed at finding the correlation between clinical and radiological outcomes after surgery with transforaminal lumbar interbody fusion. Methods: A retrospective study in 35 patients who underwent transforaminal lumbar interbody fusion in a period of 1 year was done. Preoperative pain (VAS Score), functional ability (ODI), radiological parameters (slip angle, slip grade, disc height, foraminal height, lumbar lordosis) were compared with postoperative recordings at the last followup. Functional improvement (Macnab's criteria) and fusion (Lee's fusion criteria) were assessed. Statistical analysis was done with student's paired t-test and Pearson's correlation coefficient. Results: VAS score, ODI improved from 8 to 2 and 70 to 15 respectively. Slip angle improved from 23°to 5°on an average. 80% patients showed fusion and 85% showed good clinical outcome at 1 year followup. Analyzing with Pearson correlation coefficient showed no significant relation between pain scores and radiological parameters. But there was statistically significant relation between radiological fusion and the final clinical outcome. Conclusion: TLIF produces spinal fusion in most individuals. Strong spinal fusion is essential for good clinical outcome in spondylolisthesis patients who undergo TLIF. Reduction in slip is not necessary for all patients with listhesis.
The Spine Journal, 2017
The aim of the present study was to analyze outcome, with respect to functional disability, pain, fusion rate, and complications of patients treated with transforaminal lumbar interbody fusion (TLIF) in compared to instrumented poserolateral fusion (PLF) alone, in low back pain. Spinal fusion has become a major procedure worldwide. However, conflicting results exist. Theoretical circumferential fusion could improve functional outcome. However, the theoretical advantages lack scientific documentation. Methods Prospective randomized clinical study with a 2-year follow-up period. From November 2003 to November 2008 100 patients with severe low back pain and radicular pain were randomly selected for either posterolateral lumbar fusion [titanium TSRH (Medtronic)] or transforaminal lumbar interbody fusion [titanium TSRH (Medtronic)] with anterior intervertebral support by tantalum cage (Implex/Zimmer). The primary outcome scores were obtained using Dallas Pain Questionnaire (DPQ), Oswestry disability Index, SF-36, and low back pain Rating Scale. All measures assessed the endpoints at 2-year follow-up after surgery. Results The overall follow-up rate was 94 %. Sex ratio was 40/58. 51 patients had TLIF, 47 PLF. Mean age 49(TLIF)/45(PLF). No statistic difference in outcome between groups could be detected concerning daily activity, work leisure, anxiety/depression or social interest. We found no statistic difference concerning back pain or leg pain. In both the TLIF and the PLF groups the patients had significant improvement in functional outcome, back pain, and leg pain compared to preoperatively. Operation time and blood loss in the TLIF group were significantly higher than in the PLF group (p \ 0.001). No statistic difference in fusion rates was detected. Conclusions Transforaminal interbody fusion did not improve functional outcome in patients compared to posterolateral fusion. Both groups improved significantly in all categories compared to preoperatively. Operation time and blood loss were significantly higher in the TLIF group.
International Journal of Orthopaedics Sciences, 2020
Background: Lumbar interbody fusion is an established and widely accepted procedure for degenerative spondylolisthesis. There are various fusion techniques and choosing one technique over the other remains controversial. Objective of our study was to review the long term functional and radiological outcome of traditional open transforaminal lumbar inter body fusion (TLIF) for this condition. Design: Prospective cohort study. Methods: This prospective study was conducted on 43 symptomatic adult degenerative spondylolisthesis patients, treated with traditional open TLIF and posterior instrumentation at a tertiary care centre with a mean age of 48.2years(range 26-59 year). Functional outcome and complications were assessed clinicoradiologically with a mean follow-up of 47.6 months (range18-65 months). Results: 34 patients (80%) were rated excellent, 7 patients (15%) were rated good and 2 patients (5%) were rated poor based on the pre and postoperative questionnaire scores. Visual analogue scale (VAS) pain score improved from 7.7 preoperatively to 2.5 at the latest follow-up. Preoperative Oswestry disability index (ODI) averaged 33.8 and postoperatively improved to 63.7 out of 100. Radiographic bony fusion occurred in 41 patients (95%) at final follow-up. Retropulsion of the cage into spinal canal occurred in one patient and no other major complications happened. Conclusion: Traditional open TLIF achieved excellent functional outcome and high fusion rate in our study at a long-term follow-up, which is comparable to any other fusion technique.
Journal of Neurological Disorders, 2015
Objectives: The present study aims to assess the results of extended Transforaminal Lumbar Interbody Fusion (TLIF) for a two-surgeon, single institution series. Methods: 57 cases of extended TLIF with bilateral decompression were performed. Pain, ASIA scores, patient demographics, BMI, perioperative indices and radiographic measurements were recorded and analysed. Results: 57 operations were performed between February 2011 and January 2014, there were 38 female and 19 male patients. Mean patient age was 62.86 years, mean BMI was 30.31 kg/m2. In 49 patients spondylolisthesis was the primary indication. The mean intraoperative time was 284.65 min, this decreased as the series progressed. The median length of stay was 5 days, ranging from 2 to 9 days. The surgical complication rate was 22.8%. Two patients died from cardiopulmonary complications. 78.9% of the cohort had single-level TLIF, L4/5 was the most commonly fused level. Significant pain reduction was achieved from a mean Pre-operative VAS of 8.28 1.39 to post-op VAS of 1.501.05 at 12 months. No patients deteriorated neurologically. Spondylolisthesis was significantly corrected from a pre-operative mean of 6.82 mm to 2.80 mm post-operatively. There is a learning curve associated with the procedure. Discussion: TLIF with bilateral facet joint removal and decompression appeared to be a safe and effective alternative to other fusion techniques, and is comparable to other published case series. Stabilisation and correction of spinal deformity reduces pain, aids neurologic recovery and improves quality of life.
Asian spine journal, 2011
This is a retrospective case study. This study was designed to analyze the surgical outcomes of patients who underwent minimally invasive transforaminal lumbar interbody fusion (TLIF) for the treatment of spondylolisthesis and degenerative segmental instability. If the surgical outcomes of a procedure are evaluated together with multiple indications, it is not clear how the procedure helped each subgroup of patients. For the reason that some indications achieve better outcomes than the others, we performed a subgroup analysis using validated outcome measures to demonstrate the optimal indications and the treatment results of TLIF. We conducted subgroup analyses by comparing the prospectively collecting data from the consecutive patients who underwent single-level minimally invasive TLIF for the treatment of the following 3 subgroups of indications: 23 cases of low-grade spondylolytic spondylolisthesis, 24 cases of degenerative spondylolisthesis, and 19 cases of degenerative segmenta...
Neurosurgical focus, 2017
OBJECTIVE Lumbar spondylolisthesis is a degenerative condition that can be surgically treated with either open or minimally invasive decompression and instrumented fusion. Minimally invasive surgery (MIS) approaches may shorten recovery, reduce blood loss, and minimize soft-tissue damage with resultant reduced postoperative pain and disability. METHODS The authors queried the national, multicenter Quality Outcomes Database (QOD) registry for patients undergoing posterior lumbar fusion between July 2014 and December 2015 for Grade I degenerative spondylolisthesis. The authors recorded baseline and 12-month patient-reported outcomes (PROs), including Oswestry Disability Index (ODI), EQ-5D, numeric rating scale (NRS)-back pain (NRS-BP), NRS-leg pain (NRS-LP), and satisfaction (North American Spine Society satisfaction questionnaire). Multivariable regression models were fitted for hospital length of stay (LOS), 12-month PROs, and 90-day return to work, after adjusting for an array of p...
Bratislavské lekárske listy, 2021
BACKGROUND: Lumbar spondylolisthesis is a relatively common cause of low back and lower extremity pain. The most common type, degenerative lumbar spondylolisthesis (DLS), is a disease that causes stenosis of the spinal canal. Two surgical methods of treatment are widely accepted, namely posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF). MATERIALS AND METHODS: Between 2015 and 2017, the fi ndings of 333 consecutive DLS patients who underwent surgical decompression with instrumented fusion were analyzed in a prospective study at the
Open Access Macedonian Journal of Medical Sciences
BACKGROUND: The safety and efficacy of transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis have not been validated in many prospective randomized trials. AIM: We aimed to validate the safety and efficacy of TLIF and PLIF surgery in lumbar spondylolisthesis using the clinical, radiographic, and cost-utility outcomes. METHODS: The data of surgically treated single-level spondylolisthesis patients were randomized prospectively into two groups. The groups were compared regarding demographics, perioperative complications, hospital stay, total expenditure, fusion rate, and clinical outcomes (visual analog scale, Oswestry disability index, Zurich claudication scale, and Odom’s criteria). A review of literature was done to compare the outcomes with the ones from higher-income nations. RESULTS: Thirty-three patients underwent prospective randomization. The improvement in the clinical outcomes at 12-month follow-up showed impr...
Minimally invasive transforaminal lumbar interbody fusion and spondylolisthesis
Journal of Clinical Neuroscience, 2012
The purpose of this study was to assess the clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) surgery for lumbar spondylolisthesis. A prospective analysis was conducted of 23 consecutive patients with grade I or grade II lumbar spondylolisthesis who underwent a MI-TLIF using image guidance between August 2008 and September 2010. The patient group comprised 13 males and 10 females (mean age 57 years), 22 of whom underwent single level fusion and one patient with a two level fusion. All patients underwent postoperative CT scans to assess pedicle screw and cage placement and fusion at six months. The Oswestry Disability Index (ODI) scores were recorded preoperatively and at the six-month follow-up. We found that 22 of 23 (95.7%) patients showed evidence of fusion at six months with a mean improvement of 26.7 on ODI scores. The mean length of hospital stay was four days. The mean operative time was 172 minutes. Anatomical reduction of the spondylolisthesis was complete in 16 patients and incomplete in seven. Regarding complications, we observed: one of 94 (1.1%) pedicle screws misplaced, which did not require revision postoperatively; one of 23 patients (4.3%) with a pulmonary embolism and one of 23 (4.3%) patients with transient nerve root pain. There were no occurrences of infection and no postoperative cerebrospinal fluid leaks. We conclude that MI-TLIF offers patients a safe and effective surgical option for lumbar spondylolisthesis treatment. Furthermore, it may offer patients additional advantages in terms of postoperative pain and recovery.