Address of correspondence: Mumbai Spine Scoliosis and Disc Replacement Centre.Bombay Hospital, Mumbai
Objective– To compare the clinical outcomes of open and minimally invasivetrans-foraminal lumbar interbody fusion (TLIF).
Summary of Background Data–
Published outcomes of single-level TLIF are equivalent or better than anterior and 360-degree fusions, with restorationof the disc space height. Since its introduction in 1982,TLIF has been performed for various pathologies with good long-term outcomes.Minimally invasive techniques have been applied to the TLIF procedure with the aim of smaller incisions, lesser postoperative pain, quicker mobilization, lesser blood loss and shorter hospital stay. The aim of the present study is to evaluate whether the touted advantages of Minimal Invasive-TLIF (MI-TLIF) translate into superior, equal or inferior outcomes as compared to open TLIF (O-TLIF).
Material and Methods-
The study period extended from January 2011 to July 2013.All consecutive cases of open and MI-TLIF were prospectively followed-up. All cases of discitis, failed back, single level TLIF with additional level discectomy or decompression and multilevel TLIFs were excluded from this study. MI-TLIF surgeries involved use of tubular retractors for the decompression and disc preparation procedure. The pedicle screws and rods were inserted percutaneously.
The patients were prospectively followed up and outcomes were measured in the form of pre-operative and post-operative Oswestry DisabilityIndex (ODI) and Visual Analogue Scale (VAS) for back pain and leg pain. The length of hospital stay, operative time, radiation exposure and blood loss were also compared between the two groups. The parameters were analysed using IBM® SPSS® Statistics version 17.
In all 129 patients underwent TLIF procedure during the study period of which, 71 patients (46 MI-TLIF and 25 O-TLIF) fulfilled the inclusion criteria. Of these, a further 10 were excluded on account of insufficient data and/or no follow-up.
In the MI-TLIF group, there were 26 females and 10 males, with an average age of 51.55 years. The average follow-up was 25.41 months (18-30 months). The average change in ODI was 61.79+33.49(%). The average change in VAS score for leg pain was 70.12+39.19(%) and for back pain was 50.17+38.39(%). There was one case each of transient foot-drop and bowel bladder incontinence, which recovered completely.
In the O-TLIF group, there were11 males and 14 females, with an average age of 50.4. The average follow-up was 25.24 months(18-30 months).The average change in ODI was 67.77+ 32.25(%) .The average change in VAS score for leg pain was 75.04+35.74(%) and for back pain was 45.79+41.89(%). No complications were encountered in this group.
The operative time (O-TLIF 2.96 hours + 0.57, MI-TLIF 3.40 hours + 0.54, p<0.05) was longer in MIS group. The duration of hospital stay (O-TLIF 5.84 days + 2.249, MI-TLIF 4.11 days +1.8,p<0.05) was shorter in MI-TLIF cases. There was less blood loss (Open 358.8 ml, MIS 111.81 ml, p<0.05) in MI-TLIF cases. On an average 57.77 fluoroscopic shoots were required in MI-TLIF which was significantly higher than in O-TLIF (8.2 shoots).There was no statistically significant difference in the improvement in ODI and VAS scores in MI-TLIF and O-TLIF groups.
The MI-TLIF procedure has a steep learning curve (longer operative time) and significant radiation exposure.The present study demonstrates no significant difference in the improvement of ODI and VAS scores in MI-TLIF and O-TLIF groups. But lesser blood loss, lesser hospital stayleading to earlier mobilization and consequent reduced hospital costs, make MI-TLIF an attractive and an effective alternative to O-TLIF.
How to Cite this Abstract
Pisal T, Bhute N, Patil V, Kulkarni A. MINIMAL INVASIVE TLIF VS. OPEN TLIF: IS LESS MORE ?. International Journal of Conference Proceedings. 2015;(2015):61