A Comparison of Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion for Grade 1 Degenerative Lumbar Spondylolisthesis: An Analysis of the Prospective Quality Outcomes Database. (1st September 2019)

• Record Type: Journal Article
• Authors: Chan, Andrew Kai-Hong; Bisson, Erica F; Bydon, Mohamad; 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 G; Slotkin, Jonathan; Asher, Anthony L; Virk, Michael S; Kerezoudis, Panagiotis; Alvi, Mohammed A; Guan, Jian; Haid, Regis W; Mummaneni, Praveen V
• Is Part Of: Neurosurgery. Volume 66(2010)Supplement 1
• Publication Date: 2019-09-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyz310_411
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Here, we compare minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) to traditional, open TLIF for grade 1 degenerative lumbar spondylolisthesis in the largest study to date by sample size. METHODS: We utilized the multicenter, prospective Quality Outcomes Database registry and queried patients with grade 1 degenerative lumbar spondylolisthesis who underwent single-segment surgery with fully minimally invasive or open TLIF methods. Outcomes were compared 24 mo postoperatively: Oswestry Disability Index (ODI), Numeric Rating Scale Back Pain (NRS-BP), NRS Leg Pain (NRS-LP), EuroQol-5D (EQ-5D), North American Spine Society (NASS) Satisfaction Score, cumulative reoperation rate, and return to work (RTW) rate. Multivariate analyses were utilized to adjust for variables reaching P < .20 on univariate analyses. RESULTS: A total of 297 patients were included: 72 (24.2%) MI-TLIF and 225 (75.8%) open TLIF. Average age (MI-TLIF: 62.1 vs open TLIF: 59.5 yr) was similar ( P = .10). MI-TLIF surgeries were associated with lower body mass index (29.5 ± 5.1 vs 31.3 ± 7.0, P = .0497) and more workman's compensation cases (11.1% vs 1.3%, P = .001). Patients did not differ significantly at baseline for ODI, NRS BP, NRS LP and EQ-5D ( P > .05). MI-TLIF was associated with less blood loss (108.8 ± 85.6 vs 299.6 ± 242.2 mL, P < .001), longer operations (228.2 ± 111.5 vs 189.6 ± 66.5 min, P < .001), and a trend toward decreased length of hospitalization (2.9 ± 1.8 vs 3.3 ± 1.6 d, P = 0.08). Discharge disposition to home or home healthcare was similar (94.4% vs 91.1%, P = .38). Both cohorts improved significantly from baseline for 24-month ODI, NRS-BP, NRS-LP, and EQ-5D ( P > .001). In adjusted analyses, MI-TLIF was associated with superior ODI (ß = −4.7; 95% CI-9.3 −0.04; P = .048) and EQ-5D (ß = 0.06; 95% CI 0.009-0.11; P = .02). Though trends for superiority were evident for MI-TLIF, they did not reach statistical significance for NRS-BP ( P = .06), NRS-LP ( P = .07), and NASS Satisfaction ( P = .06). Similarly, there was a trend for fewer reoperations following MI-TLIF, though this did not reach statistical significance (1.4% vs 7.6%, P = .10). A higher proportion of MI-TLIF patients were able to RTW following surgery (100% vs 80%, P = .02). CONCLUSION: For single-level grade 1 degenerative lumbar spondylolisthesis, MI-TLIF was associated with superior outcomes for disability and quality of life compared with traditional, open TLIF. MI-TLIF was associated with higher rates of RTW and less blood loss, but longer operative times.