scholarly journals Clinical and Radiographic Outcomes After Minimally Invasive Transforaminal Lumbar Interbody Fusion—Early Experience Using a Biplanar Expandable Cage for Lumbar Spondylolisthesis

10.14444/7125 ◽  
2020 ◽  
Vol 14 (s3) ◽  
pp. S39-S44
Author(s):  
Lee A. Tan ◽  
Joshua Rivera ◽  
Xiao A. Tan ◽  
Vivian P. Le ◽  
Larry T. Khoo ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Early Experience ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Expandable Cage ◽  
Radiographic Outcomes ◽  
Lumbar Spondylolisthesis

scholarly journals Effect of Cage Type on Immediate Postoperative Radiographic Outcomes in Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF)

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Avani Vaishnav ◽  
Joshua Wright-Chisem ◽  
Michael Steinhaus ◽  
Steven Mcanany ◽  
Sravisht Iyer ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Expandable Cage ◽  
Radiographic Outcomes ◽  
Radiographic Parameters ◽  
Significant Difference ◽  
Segmental Lordosis ◽  
Foraminal Height

Abstract INTRODUCTION The type of cage used in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) can impact several goals of the procedure, including optimizing disc and foraminal height, interbody fusion, and sagittal balance. METHODS Segmental lordosis (SL), lumbar lordosis (LL), posterior disc height (PDH) were compared using upright lateral radiographs obtained pre- and postoperatively. Impact of demographic (age, sex, and BMI), preoperative radiographic (SL, LL, and PDH) and operative factors (cage-type, cage-width, and cage-position) on radiographic outcomes were assessed. RESULTS Of the 154 patients included, 55 received a static oblique, 63 a static articulating, and 36 an expandable articulating cage. There was no significant difference in SL pre- (P = .389) or postoperatively (P = .613). A difference was seen in change in SL (P = .023), with the expandable articulating cage showing the greatest increase, and an improvement from pre- to postoperatively (P = .033). A significant difference was seen in change in LL (P = .050), with the static oblique and expandable articulating groups maintaining LL (P = .238 and P = .873), but the static articulating group showing decrease in LL (P < .0001). There was a significant difference in PDH pre- and postoperatively (P < .0001 and P = .045). All three cages increased in PDH (P < .0001), with the expandable articulating cage showing the greatest increase (P = .009). Regressions showed that preoperative SL was the only significant predictor of postoperative SL (P < .0001; R2 = 0.418) and change in SL (P < .0001; R2 = 0.247); preoperative LL of postoperative LL (P < .0001; R2 = 0.609) and change in LL (P < .0001; R2 = 0.227); and preoperative PDH of postoperative PDH (P < .0001; R2 = 0.360) and change in PDH (P < .0001; R2 = 0.299). Cage-type, cage-position, and cage-width were not significant predictors of radiographic parameters. CONCLUSION Preoperative radiographic parameters were predictors of postoperative parameters. While the static cages maintained SL, the expandable cage increased SL. The expandable cage had the lowest preoperative PDH, likely reflective of the expandable technology allowing for cage-insertion even in collapsed disc spaces. The expandable articulating cage demonstrated benefit in increasing SL, maintaining LL and causing the greatest increase in PDH.

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

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. 555-562 ◽  
Author(s):  
Andrew K Chan ◽  
Erica F Bisson ◽  
Mohamad Bydon ◽  
Kevin T Foley ◽  
Steven D Glassman ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Sample Size ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Small Sample ◽  
Lumbar Interbody Fusion ◽  
Quality Outcomes ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lumbar Spondylolisthesis

ABSTRACT BACKGROUND It remains unclear if minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is comparable to traditional, open TLIF because of the limitations of the prior small-sample-size, single-center studies reporting comparative effectiveness. OBJECTIVE To compare 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 prospective Quality Outcomes Database registry and queried patients with grade 1 degenerative lumbar spondylolisthesis who underwent single-segment surgery with MI- or open TLIF methods. Outcomes were compared 24 mo postoperatively. RESULTS A total of 297 patients were included: 72 (24.2%) MI-TLIF and 225 (75.8%) open TLIF. MI-TLIF surgeries had lower mean body mass indexes (29.5 ± 5.1 vs 31.3 ± 7.0, P = .0497) and more worker's compensation cases (11.1% vs 1.3%, P &lt; .001) but were otherwise similar. MI-TLIF had less blood loss (108.8 ± 85.6 vs 299.6 ± 242.2 mL, P &lt; .001), longer operations (228.2 ± 111.5 vs 189.6 ± 66.5 min, P &lt; .001), and a higher return-to-work (RTW) rate (100% vs 80%, P = .02). Both cohorts improved significantly from baseline for 24-mo Oswestry Disability Index (ODI), Numeric Rating Scale back pain (NRS-BP), NRS leg pain (NRS-LP), and Euro-Qol-5 dimension (EQ-5D) (P &gt; .001). In multivariable adjusted analyses, MI-TLIF was associated with lower ODI (β = −4.7; 95% CI = −9.3 to −0.04; P = .048), higher EQ-5D (β = 0.06; 95% CI = 0.01-0.11; P = .02), and higher satisfaction (odds ratio for North American Spine Society [NASS] 1/2 = 3.9; 95% CI = 1.4-14.3; P = .02). Though trends favoring MI-TLIF were evident for NRS-BP (P = .06), NRS-LP (P = .07), and reoperation rate (P = .13), these results did not reach statistical significance. CONCLUSION For single-level grade 1 degenerative lumbar spondylolisthesis, MI-TLIF was associated with less disability, higher quality of life, and higher patient satisfaction compared with traditional, open TLIF. MI-TLIF was associated with higher rates of RTW, less blood loss, but longer operative times. Though we utilized multivariable adjusted analyses, these findings may be susceptible to selection bias.

scholarly journals 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

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Andrew Kai-Hong Chan ◽  
Erica F Bisson ◽  
Mohamad Bydon ◽  
Steven D Glassman ◽  
Kevin T Foley ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Statistical Significance ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Home Healthcare ◽  
Lumbar Interbody Fusion ◽  
Quality Outcomes ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lumbar Spondylolisthesis

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.

65. Subsidence after minimally invasive transforaminal lumbar interbody fusion with expandable cage: Rates and clinical impact

2021 ◽  
Vol 21 (9) ◽  
pp. S32
Author(s):  
Michael E. Steinhaus ◽  
Avani S. Vaishnav ◽  
Sachin Shah ◽  
Nicholas Clark ◽  
Chirag Chaudhary ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Clinical Impact ◽  
Lumbar Interbody Fusion ◽  
Expandable Cage
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