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Clinical Trial
. 2014 Feb 1;39(3):E191-8.
doi: 10.1097/BRS.0000000000000078.

Quality-of-life Outcomes With Minimally Invasive Transforaminal Lumbar Interbody Fusion Based on Long-Term Analysis of 304 Consecutive Patients

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Free PMC article
Clinical Trial

Quality-of-life Outcomes With Minimally Invasive Transforaminal Lumbar Interbody Fusion Based on Long-Term Analysis of 304 Consecutive Patients

Mick J Perez-Cruet et al. Spine (Phila Pa 1976). .
Free PMC article

Abstract

Study design: This was a prospective clinical study that took place in an outpatient spine clinic.

Objective: To demonstrate the short-/long-term outcomes from a large cohort of patients undergoing minimally invasive transforaminal lumbar interbody fusion (MITLIF).

Summary of background data: Long-term prospective outcomes in patients undergoing minimally invasive spinal fusion for debilitating back pain has not been well studied.

Methods: Presenting diagnosis was determined from clinical findings and radiographical (radiograph, magnetic resonance image, computed tomographic scan) evaluations preoperatively. Patients were assessed with outcome measures preoperatively, and postoperatively at 2 weeks, 3 months, 6 months, 12 months, 24 months, and annually 2 to 7 years (mean follow-up: 47 mo) final follow-up. The rate of postoperative complications and reoperations at the initial level of MITLIF and adjacent level(s) were followed. Fusion rates were assessed blinded and independently by radiograph.

Results: Visual analogue scale scores decreased significantly from 7.0 preoperatively to 3.5 at mean 47-month follow-up. Oswestry Disability Index scores declined from 43.1 preoperatively to 28.2 at mean 47-month follow-up. Short-Form 36 mental component scores increased from 43.8 preoperatively to 49.7 at 47-month follow-up. Short-Form 36 physical component scores increased from 30.6 preoperatively to 39.6 at 47-month follow-up (P < 0.05).

Conclusion: This prospectively collected outcomes study shows long-term statistically significant clinical outcomes improvement after MITLIF in patients with clinically symptomatic spondylolisthesis and degenerative disc disease with or without stenosis. MITLIF resulted in a high rate of spinal fusion and very low rate of interbody fusion failure and/or adjacent segment disease requiring reoperation while reducing postoperative complications.

Level of evidence: 3.

Figures

Figure 1.
Figure 1.
Line graph demonstrating mean VAS scores over time (P < 0.001 for 2-week to 24-month follow-up scores). *Lower VAS scores show improvement. VAS indicates visual analogue scale.
Figure 2.
Figure 2.
Line graph demonstrating mean ODI scores over time (P < 0.001 for 2-wk to 24-mo follow-up scores; P < 0.05 for 47-month follow-up score). *Lower ODI scores show improvement. ODI indicates Oswestry Disability Index.
Figure 3.
Figure 3.
Line graph demonstrating mean SF-36 PCS and MCS over time (P < 0.001 for 2-wk to 24-mo follow-up scores; P < 0.05 for 47-month follow-up scores). *Higher SF-36 scores show improvement. PCS indicates physical component score; MCS, mental component scores; SF-36, Short-Form 36.
Figure 4.
Figure 4.
A 55-year-old female presents with severe refractory back pain and neurogenic claudication. Preoperative T2-weighted sagittal (A), and axial (B) MR images show L4–L5 grade 1 spondylolisthesis with associated spinal stenosis. Postoperative sagittal (C), and axial (D) CT images, and healed incision (E) after L4–L5 MIS laminectomy and MITLIF. Patient made an uneventful recovery with resolution of symptoms and return to work. MITLIF indicates minimally invasive transforaminal lumbar interbody fusion; MR, magnetic resonance; CT, computed tomography; MIS, minimally invasive spine.
Figure 5.
Figure 5.
A 68 year-old female presenting with severe debilitating back pain and neurogenic claudication. Preoperative T2-weighted sagittal (A), and axial (B) MR images at the L3–L4 level showing stenosis, and L4–L5 MR image (C, D) showing stenosis and grade 1 spondylolisthesis. Postoperative corresponding sagittal and axial CT (EH) showing MIS laminectomy at L3–L4 and L4–L5 levels with MITLIF at the L4–L5 level. Patient made an uneventful recovery with resolution of symptoms and return to activities of daily living. MITLIF indicates minimally invasive transforaminal lumbar interbody fusion; MR, magnetic resonance; CT, computed tomography; MIS, minimally invasive spine.
Figure 6.
Figure 6.
A 46-year-old male presenting with severe debilitating back pain from L4–L5 and L5–S1 grade 1 spondylolisthesis. Preoperative plain radiographs (A), and postoperative lateral (B) and anteroposterior (C) view after 2 level L4–L5 and L5–S1 MITLIF. Postoperative healed incision (D). Patient made an uneventful recovery with resolution of symptoms and return to work. MITLIF indicates minimally invasive transforaminal lumbar interbody fusion.
Figure 7.
Figure 7.
A 71 year-old male with severe debilitating back pain. Status post-traditional L2–L5 multilevel lumbar laminectomy. Preoperative (A) plain lateral radiograph, sagittal MR image (B, C), sagittal (D) and axial (E) CT showing L4–L5 grade 2 spondylolisthesis, severe bilateral foraminal stenosis, and air in the L4–L5 disc space. Postoperative (F) plain radiograph, and incision (G) after L4–L5 MITLIF. Patient made an uneventful recovery with resolution of symptoms. MITLIF indicates minimally invasive transforaminal lumbar interbody fusion; MR, magnetic resonance; CT, computed tomography.

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