Top

Published in:

Open Access 06-09-2022 | Spondylolisthesis | Research

Minimally invasive versus open transforaminal lumbar interbody fusion: a prospective, controlled observational study of short-term outcome

Authors: Sebastian Hartmann, Anna Lang, Sara Lener, Anto Abramovic, Lukas Grassner, Claudius Thomé

Published in: Neurosurgical Review | Issue 5/2022

Abstract

Instrumented stabilization with intersomatic fusion can be achieved by open (O-TLIF) or minimally invasive (MIS-TLIF) transforaminal surgical access. While less invasive techniques have been associated with reduced postoperative pain and disability, increased manipulation and insufficient decompression may contradict MIS techniques. In order to detect differences between both techniques in the short-term, a prospective, controlled study was conducted. Thirty-eight patients with isthmic or degenerative spondylolisthesis or degenerative disk disease were included in this prospective, controlled study (15 MIS-TLIF group vs. 23 O-TLIF group) after failed conservative treatment. Patients were examined preoperatively, on the first, third, and sixth postoperative day as well as after 2, 4, and 12 weeks postoperatively. Outcome parameters included blood loss, duration of surgery, pre- and postoperative pain (numeric rating scale [NRS], visual analog scale [VAS]), functionality (Timed Up and Go test [TUG]), disability (Oswestry Disability index [ODI]), and quality of life (EQ-5D). Intraoperative blood loss (IBL) as well as postoperative blood loss (PBL) was significantly higher in the O-TLIF group ([IBL O-TLIF 528 ml vs. MIS-TLIF 213 ml, p = 0.001], [PBL O-TLIF 322 ml vs. MIS-TLIF 30 ml, p = 0.004]). The O-TLIF cohort showed significantly less leg pain postoperatively compared to the MIS-TLIF group ([NRS leg 3rd postoperative day, p = 0.027], [VAS leg 12 weeks post-op, p = 0.02]). The MIS group showed a significantly better improvement in the overall ODI (40.8 ± 13 vs. 56.0 ± 16; p = 0.05). After 3 months in the short-term follow-up, the MIS procedure tends to have better results in terms of patient-reported quality of life. MIS-TLIF offers perioperative advantages but may carry the risk of increased nerve root manipulation with consecutive higher radicular pain, which may be related to the learning curve of the procedure.

Adogwa O, Parker SL, Bydon A, Cheng J, McGirt MJ (2011) Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion. J Spinal Disord Tech 24:1. https://doi.org/10.1097/BSD.0b013e3182055cacCrossRef

Balestroni G, Bertolotti G (2015) EuroQol-5D (EQ-5D): an instrument for measuring quality of life. Monaldi Arch Chest Dis 78:23614330. https://doi.org/10.4081/monaldi.2012.121CrossRef

Briggs M, Closs JS (1999) A descriptive study of the use of visual analogue scales and verbal rating scales for the assessment of postoperative pain in orthopedic patients. J Pain Symptom Manag 18:438–446. https://doi.org/10.1016/S0885-3924(99)00092-5CrossRef

Brox JI, Reikerås O, Nygaard Ø, Sørensen R, Indahl A, Holm I, Keller A, Ingebrigtsen T, Grundnes O, Lange JE, Friis A (2006) Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study. Pain 122:145–155. https://doi.org/10.1016/j.pain.2006.01.027CrossRefPubMed

Carreon LY, Puno RM, Dimar JR, Glassman SD, Johnson JR (2003) Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Jt Surg - Ser A 85:2089–2092. https://doi.org/10.2106/00004623-200311000-00004CrossRef

Deyo RA, Nachemson A, Mirza SK (2004) Spinal-fusion surgery — the case for restraint. N Engl J Med 350:722–726. https://doi.org/10.1056/NEJMsb031771CrossRefPubMed

Epstein N (2015) Open laminoforaminotomy: a lost art? Surg Neurol Int 6:S600–S607. https://doi.org/10.4103/2152-7806.170435CrossRefPubMedPubMedCentral

Eriksson K, Wikström L, Årestedt K, Fridlund B, Broström A (2014) Numeric rating scale: patients’ perceptions of its use in postoperative pain assessments. Appl Nurs Res 27:41–46. https://doi.org/10.1016/j.apnr.2013.10.006CrossRefPubMed

Fairbank JC, Pynsent PB (2000) The Oswestry Disability Index. Spine (Phila Pa 1976) 25:2940–52; discussion 2952. https://doi.org/10.1097/00007632-200011150-00017

10.

Fan G, Wu X, Yu S, Sun Q, Guan X, Zhang H, Gu X, He S (2016) Clinical outcomes of posterior lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion in three-level degenerative lumbar spinal stenosis. Biomed Res Int 2016.https://doi.org/10.1155/2016/9540298

11.

Fan S, Hu Z, Zhao F, Zhao X, Huang Y, Fang X (2010) Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. Eur Spine J 19:316–324. https://doi.org/10.1007/s00586-009-1191-6CrossRefPubMed

12.

Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP (2011) Validity of four pain intensity rating scales. Pain 152:2399–2404. https://doi.org/10.1016/j.pain.2011.07.005CrossRefPubMed

13.

Fritzell P, Hagg O, Wessberg P, Nordwall A (2001) 2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976) 26:2521–2524. https://doi.org/10.1097/00007632-200112010-00002

14.

Goldstein CL, Macwan K, Sundararajan K, Rampersaud YR (2014) Comparative outcomes of minimally invasive surgery for posterior lumbar fusion: a systematic review. Clin Orthop Relat Res 472:1727–1737. https://doi.org/10.1007/s11999-014-3465-5CrossRefPubMedPubMedCentral

15.

Goldstein CL, Phillips FM, Rampersaud YR (2016) Comparative effectiveness and economic evaluations of open versus minimally invasive posterior or transforaminal lumbar interbody fusion. Spine (Phila Pa 1976) 41:s74–s89. https://doi.org/10.1097/BRS.0000000000001462

16.

Hackenberg L, Halm H, Bullmann V, Vieth V, Schneider M, Liljenqvist U (2005) Transforaminal lumbar interbody fusion: a safe technique with satisfactory three to five year results. Eur Spine J 14:551–558. https://doi.org/10.1007/s00586-004-0830-1CrossRefPubMedPubMedCentral

17.

Harms JG, Jeszenszky D (1998) Die posteriory lumbale, interkorporelle Fusion in unilateraler transforaminaler Technik. Oper Orthop Traumatol 10:90–102. https://doi.org/10.1007/s00064-006-0112-7CrossRefPubMed

18.

Hartmann S, Hegewald AA, Tschugg A, Neururer S, Abenhardt M, Thomé C (2016) Analysis of a performance-based functional test in comparison with the visual analog scale for postoperative outcome assessment after lumbar spondylodesis. Eur Spine J 25:1620–1626. https://doi.org/10.1007/s00586-015-4350-yCrossRefPubMed

19.

Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, Fainsinger R, Aass N, Kaasa S (2011) Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manag 41:1073–1093. https://doi.org/10.1016/j.jpainsymman.2010.08.016CrossRef

20.

Hu SS (2004) Blood loss in adult spinal surgery. 13:3–5.https://doi.org/10.1007/s00586-004-0753-x

21.

Karikari IO, Isaacs RE (2010) Minimally invasive transforaminal lumbar interbody fusion: a review of techniques and outcomes. Spine (Phila Pa 1976) 35:S294; S301–S294; S301. https://doi.org/10.1097/BRS.0b013e3182022ddc

22.

Keorochana G, Setrkraising K, Woratanarat P, Arirachakaran A, Kongtharvonskul J (2018) Clinical outcomes after minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion for treatment of degenerative lumbar disease: a systematic review and meta-analysis. Neurosurg Rev 41:755–770. https://doi.org/10.1007/s10143-016-0806-8CrossRefPubMed

23.

Kim CW (2010) Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine (Phila Pa 1976) 35. https://doi.org/10.1097/BRS.0b013e3182022d32

24.

Kim DY, Lee SH, Sang KC, Lee HY (2005) Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976) 30:123–129. https://doi.org/10.1097/01.brs.0000148999.21492.53

25.

Kim K-T, Lee S-H, Suk K-S, Bae S-C (2006) The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine (Phila Pa 1976) 31:712–716. https://doi.org/10.1097/01.brs.0000202533.05906.ea

26.

Lau D, Lee JG, Han SJ, Lu DC, Chou D (2011) Complications and perioperative factors associated with learning the technique of minimally invasive transforaminal lumbar interbody fusion (TLIF). J Clin Neurosci 18:624–627. https://doi.org/10.1016/j.jocn.2010.09.004CrossRefPubMed

27.

Lee KH, Yue WM, Yeo W, Soeharno H, Tan SB (2012) Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J 21:2265–2270. https://doi.org/10.1007/s00586-012-2281-4CrossRefPubMedPubMedCentral

28.

Lener S, Wipplinger C, Hernandez RN, Hussain I, Kirnaz S, Navarro-Ramirez R, Schmidt FA, Kim E, Härtl R (2020) Defining the MIS-TLIF: a systematic review of techniques and technologies used by surgeons worldwide. Glob Spine J 10:151S-167S. https://doi.org/10.1177/2192568219882346CrossRef

29.

Mannion AF, Vila-Casademunt A, Domingo-Sàbat M, Wunderlin S, Pellisé F, Bago J, Acaroglu E, Alanay A, Pérez-Grueso FS, Obeid I, Kleinstück FS (2016) The Core Outcome Measures Index (COMI) is a responsive instrument for assessing the outcome of treatment for adult spinal deformity. Eur Spine J 25:2638–2648. https://doi.org/10.1007/s00586-015-4292-4CrossRefPubMed

30.

Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS (2019) Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. Spine (Phila Pa 1976) 44:369–376. https://doi.org/10.1097/BRS.0000000000002822

31.

Min S-H, Kim M-H, Seo J-B, Lee J-Y, Lee D-H (2009) The quantitative analysis of back muscle degeneration after posterior lumbar fusion: comparison of minimally invasive and conventional open surgery. Asian Spine J 3:89. https://doi.org/10.4184/asj.2009.3.2.89CrossRefPubMedPubMedCentral

32.

Mirza SK, Deyo RA (2007) Systematic review of randomized trials comparing lumbar fusion surgery to nonoperative care for treatment of chronic back pain. Spine (Phila Pa 1976) 32:816–823. https://doi.org/10.1097/01.brs.0000259225.37454.38

33.

Möller H, Hedlund R (2000) Surgery versus conservative management in adult isthmic spondylolisthesis - a prospective randomized study: Part 1. Spine (Phila Pa 1976) 25:1711–1715. https://doi.org/10.1097/00007632-200007010-00016

34.

Neal CJ, Rosner MK (2010) Resident learning curve for minimal-access transforaminal lumbar interbody fusion in a military training program. Neurosurg Focus 28:E21. https://doi.org/10.3171/2010.1.FOCUS1011CrossRefPubMed

35.

Ntoukas V, Müller A (2010) Minimally invasive approach versus traditional open approach for one level posterior lumbar interbody fusion. Minim Invasive Neurosurg 53:21–24. https://doi.org/10.1055/s-0030-1247560CrossRefPubMed

36.

Park Y, Ha JW (2007) Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach. Spine (Phila Pa 1976) 32:537–543. https://doi.org/10.1097/01.brs.0000256473.49791.f4

37.

Parker SL, Adogwa O, Witham TF, Aaronson OS, Cheng J, McGirt MJ (2011) Post-operative infection after minimally invasive versus open transforaminal lumbar interbody fusion (TLIF): literature review and cost analysis. Minim Invasive Neurosurg 54:33–37. https://doi.org/10.1055/s-0030-1269904CrossRefPubMed

38.

Peng CWB, Yue WM, Poh SY, Yeo W, Tan SB (2009) Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine (Phila Pa 1976) 34:1385–1389. https://doi.org/10.1097/BRS.0b013e3181a4e3be

39.

Phan K, Rao PJ, Kam AC, Mobbs RJ (2015) Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis. 1017–1030. https://doi.org/10.1007/s00586-015-3903-4

40.

Podsiadlo D, Richardson S (1991) The Timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:8CrossRef

41.

Rampersaud YR, Gray R, Lewis SJ, Massicotte EM, Fehlings MG (2011) Cost-utility analysis of posterior minimally invasive fusion compared with conventional open fusion for lumbar spondylolisthesis. SAS J 5:29–35. https://doi.org/10.1016/j.esas.2011.02.001CrossRefPubMedPubMedCentral

42.

Rodgers WB, Gerber EJ, Rodgers JA (2010) Lumbar fusion in octogenarians: the promise of minimally invasive surgery. Spine (Phila Pa 1976) 35:18–20. https://doi.org/10.1097/BRS.0b013e3182023796

43.

Rodríguez-Vela J, Lobo-Escolar A, Joven-Aliaga E, Herrera A, Vicente J, Suñén E, Loste A, Tabuenca A (2009) Perioperative and short-term advantages of mini-open approach for lumbar spinal fusion. Eur Spine J 18:1194–1201. https://doi.org/10.1007/s00586-009-1010-0CrossRefPubMedPubMedCentral

44.

Rodríguez-Vela J, Lobo-Escolar A, Joven E, Muñoz-Marín J, Herrera A, Velilla J (2013) Clinical outcomes of minimally invasive versus open approach for one-level transforaminal lumbar interbody fusion at the 3- to 4-year follow-up. Eur Spine J 22:2857–2863. https://doi.org/10.1007/s00586-013-2853-yCrossRefPubMedPubMedCentral

45.

Schizas C, Tzinieris N, Tsiridis E, Kosmopoulos V (2009) Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience. Int Orthop 33:1683–1688. https://doi.org/10.1007/s00264-008-0687-8CrossRefPubMed

46.

Seng C, Siddiqui MA, Wong KPL, Zhang K, Yeo W, Tan SB, Yue WM (2013) Five-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion: a matched-pair comparison study. Spine (Phila Pa 1976) 38:2049–2055. https://doi.org/10.1097/BRS.0b013e3182a8212d

47.

Shunwu F, Xing Z, Fengdong Z, Xiangqian F (2010) Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine (Phila Pa 1976) 35:1615–1620. https://doi.org/10.1097/BRS.0b013e3181c70fe3

48.

Sinoff G, Ore L (1997) The Barthel activities of daily living index: self-reporting versus actual performance in the old-old (> or = 75 years). J Am Geriatr Soc 45:832–836CrossRef

49.

Smith JS, Shaffrey CI, Sansur CA, Berven SH, Fu KMG, Broadstone PA, Choma TJ, Goytan MJ, Noordeen HH, Knapp DR, Hart RA, Donaldson WF, Polly DW, Perra JH, Boachie-Adjei O (2011) Rates of infection after spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society morbidity and mortality committee. Spine (Phila Pa 1976) 36:556–563. https://doi.org/10.1097/BRS.0b013e3181eadd41

50.

Starkweather AR, Witek-Janusek L, Nockels RP, Peterson J, Mathews HL (2008) The multiple benefits of minimally invasive spinal surgery: results comparing transforaminal lumbar interbody fusion and posterior lumbar fusion. J Neurosci Nurs 40:32–39. https://doi.org/10.1097/01376517-200802000-00006CrossRefPubMedPubMedCentral

51.

Stienen MN, Maldaner N, Joswig H, Corniola MV, Bellut D, Prömmel P, Regli L, Weyerbrock A, Schaller K, Gautschi OP (2019) Objective functional assessment using the “Timed Up and Go” test in patients with lumbar spinal stenosis. Neurosurg Focus 46:19. https://doi.org/10.3171/2019.2.FOCUS18618CrossRef

52.

Thong ISK, Jensen MP, Miró J, Tan G (2018) The validity of pain intensity measures: what do the NRS, VAS, VRS, and FPS-R measure? Scand J Pain 18:99–107. https://doi.org/10.1515/sjpain-2018-0012CrossRefPubMed

53.

Tumialán LM, Madhavan K, Godzik J, Wang MY (2019) The history of and controversy over Kambin’s triangle: a historical analysis of the lumbar transforaminal corridor for endoscopic and surgical approaches. World Neurosurg 123:402–408. https://doi.org/10.1016/j.wneu.2018.10.221CrossRefPubMed

54.

Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J (2011) Minimally invasive or open transforaminal lumbar interbody fusion as revision surgery for patients previously treated by open discectomy and decompression of the lumbar spine. Eur Spine J 20:623–628. https://doi.org/10.1007/s00586-010-1578-4CrossRefPubMed

55.

Wang MY, Cummock MD, Yu Y, Trivedi RA (2010) An analysis of the differences in the acute hospitalization charges following minimally invasive versus open posterior lumbar interbody fusion. J Neurosurg Spine 12:694–699. https://doi.org/10.3171/2009.12.SPINE09621CrossRefPubMed

56.

Wickham JEA (1987) The new surgery. Br Med J (Clin Res Ed) 295:1581–1582. https://doi.org/10.1136/bmj.295.6613.1581CrossRef

Title: Minimally invasive versus open transforaminal lumbar interbody fusion: a prospective, controlled observational study of short-term outcome
Authors: Sebastian Hartmann
Anna Lang
Sara Lener
Anto Abramovic
Lukas Grassner
Claudius Thomé
Publication date: 06-09-2022
Publisher: Springer Berlin Heidelberg
Keywords: Spondylolisthesis
Leg Pain
Leg Pain
Published in: Neurosurgical Review / Issue 5/2022
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-022-01845-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Minimally invasive versus open transforaminal lumbar interbody fusion: a prospective, controlled observational study of short-term outcome

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2022

Predictors of response for percutaneous balloon compression for the treatment of recurrent trigeminal neuralgia following surgical procedures: a retrospective study

The prognosis and treatment effectiveness of de novo aneurysm formation after radiation therapy for brain tumor

Patient-reported intraoperative experiences during awake craniotomy for brain tumors: a scoping review

Intra-procedural complications, success rate, and need for retreatment of endovascular treatments in anterior communicating artery aneurysms: a systematic review and meta-analysis

How should we treat long-standing overt ventriculomegaly in adults (LOVA)? A retrospective cohort study

Interleukin-6 as a prognostic biomarker of clinical outcomes after traumatic brain injury: a systematic review