Abstract
Purpose
The paraspinal approach and functional anatomy sparing nature of the minimally invasive transforaminal lumbar interbody fusion are thought to decrease operative morbidity while improving patient recovery and long-term outcomes. This paper presents a unique minimally invasive approach for the treatment of patients with lumbar spondylolisthesis and associated spinal stenosis. The novel technique described within allows for significant reduction of spondylolisthesis, while also utilizing a substantial amount of the patient’s morselized surgical site autograft, thus limiting the use of costly bone graft extenders. We aim to validate this technique by performing a critical analysis of postoperative patient reported outcomes with comparison to traditional open midline transforaminal lumbar interbody fusion.
Methods
Data was reviewed for 19 patients who underwent the minimally invasive transforaminal lumbar interbody fusion technique described within and subsequently compared to 140 patients who underwent traditional open midline transforaminal lumbar interbody all of whom were within the control groups of an FDA approved IDE clinical trial (NCT03115983). Operative and demographic data were collected and compared including age, gender, BMI, comorbidities, operative level, procedure time, estimated blood loss, postoperative length of stay. Pre and postoperative patient reported outcome scores were also analyzed for both groups including visual analogue score (VAS) for back and leg/hip pain and Oswestry disability index (ODI).
Results
Procedure length (minutes), estimated blood loss (mL), and length of hospital stay (days) for the patient’s undergoing minimally invasive transforaminal lumbar interbody fusion were 156 +/- 31, 72 +/- 32, and 2.6 +/- 1.8, respectively. Compared to traditional midline transforaminal lumbar interbody fusion procedure time, estimated blood loss, and length of hospital stay of 189 +/- 78, 273 +/- 252, 3.1 +/- 1.7, respectively. VAS back and leg/hip pre-operatively were 79.3, 85.3, and 52.2 versus 20.6, 20.3 and 16.9 points, respectively at 2-year follow-up for the minimally invasive approach. Compared to 69.7, 78.8, and 52.7 versus 27.9, 27.8 and 22.4 at 2-year follow-up for traditional midline approach. These improvements were all statistically significant at the 5% level.
Conclusion
The minimally invasive approach described in this paper, when compared to traditional midline transforaminal lumbar interbody fusion, resulted in shorter operative time, decreased estimated blood loss, shorter length of stay, and improvements in patient reported functional outcomes. This novel minimally invasive surgical approach to transforaminal lumbar interbody fusion is an excellent surgical treatment for refractory lumbar spondylolisthesis with associated stenosis.