Comparison of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) with bilateral decompression via unilateral approach and open-TLIF with bilateral decompression for degenerative lumbar diseases: a retrospective cohort study

Fengzhao Zhu; Dongqing Jia; Yaqing Zhang; Chencheng Feng; Ya Ning; Xue Leng; Yue Zhou; Changqing Li; Bo Huang

doi:10.1186/s13018-024-04630-1

Comparison of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) with bilateral decompression via unilateral approach and open-TLIF with bilateral decompression for degenerative lumbar diseases: a retrospective cohort study

J Orthop Surg Res. 2024 Feb 20;19(1):150. doi: 10.1186/s13018-024-04630-1.

Authors

Fengzhao Zhu¹, Dongqing Jia², Yaqing Zhang¹, Chencheng Feng¹, Ya Ning¹, Xue Leng¹, Yue Zhou¹, Changqing Li¹, Bo Huang³

Affiliations

¹ Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China.
² Department of Blood Transfusion, University-Town Hospital of Chongqing Medical University, Chongqing, China.
³ Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China. fmmuhb@126.com.

Abstract

Objective: Presently, no study has compared the clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) with bilateral decompression via the unilateral approach (BDUA) and Open-TLIF with bilateral decompression for degenerative lumbar diseases (DLD). We aimed to compare the clinical outcomes of through Mis-TLIF combined with BDUA and Open-TLIF with bilateral decompression for the treatment of DLD, and reported the learning curve of the procedure of MIS-TLIF with BDUA.

Methods: We retrospectively analyzed the prospectively collected data of consecutive DLD patients in the two groups from January 2016 to January 2020.

Results: The operative time (OT) was significantly longer in the Mis-TLIF group (n = 113) than in the Open-TLIF group (n = 135). The postoperative drainage volume (PDV) and length of stay (LOS) were significantly higher in the Open-TLIF group than in the Mis-TLIF group. Additionally, the complication rate was significantly higher in the Open-TLIF group than in the Mis-TLIF group (14.8% vs. 6.2%, P = 0.030), while there was no significant difference in the reoperation and adjacent segment disease rates between the two groups. There were no significant differences in back pain and leg pain Numerical Rating Scale (NRS) scores and Oswestry Disability Index (ODI) between the two groups preoperatively, at discharge, and 2 years postoperatively. Patients in both groups showed significant improvements in NRS scores and ODI scores after surgery. OT was negatively correlated with the number of surgeries performed (P < 0.001, r = -0.43). The learning curve of Mis-TLIF with BDUA was steep, with OT tapered to steady state in 43 cases.

Conclusion: Compared with Open-TLIF with bilateral decompression, Mis-TLIF with BDUA can achieve equivalent clinical outcomes, lower PDV and LOS, and lower complication rates. Although this procedure took longer, it could be a viable alternative for the treatment of DLD after a steep learning curve.

Keywords: Bilateral decompression via unilateral approach; Degenerative lumbar diseases; Learning curve; Minimally invasive transforaminal lumbar interbody fusion; Open-TLIF.

MeSH terms

Decompression
Humans
Lumbar Vertebrae* / surgery
Minimally Invasive Surgical Procedures / methods
Retrospective Studies
Spinal Fusion* / methods
Treatment Outcome