Introduction: Low back pain is the second most common reason patients present to the emergency department, and the most common symptom that patients present with to spine surgeons. Many of these patients have multi-level spinal stenosis and associated spondylolisthesis, which is often treated with multi-level decompression and pedicle screw fixation and fusion. These long multi-segmental constructs can have significant morbidity and lead to repeat surgeries due to adjacent level diseases. A retrospective chart review was performed to further evaluate patient outcomes scores and success rates associated with a more limited, minimally invasive unisegmental transforaminal lumbar interbody fusion (TLIF) and pedicle screw instrumentation and adjacent level(s) decompressive laminectomy.
Methods: 50 patients (mean age of 65.8, range 30 – 87) presented to our clinic with intractable low back pain and neurogenic claudication secondary to spondylolisthesis and adjacent level lumbar stenosis. Visual Analog Scale (VAS), Short Form – 36 Mental (MCS) and Physical (PCS) component, and Oswestry Disability Index (ODI) scores were analyzed preoperatively and post-operatively at 2 weeks, 3, 6, 12, and 24 months. Fusion rates were also determined through an independent assessment of dynamic radiographs.
Results: All patients were treated with unisegmental TLIF and adjacent level laminectomy (1 to 3 levels). 3 patients underwent TLIF at L2-3; 4 patients at L3-4; 34 patients at L4-L5; and 9 patients at L5-S1. These patients experienced excellent pain relief after surgery. Pre and post-operative scores from the Visual Analog Scale, Short Form – 36, and Oswestry Disability Index were recorded and analyzed. There was a statistically significant (p < 0.01) improvement in all scales. No further revision surgeries were required in this cohort of patients.
Conclusions: Minimally invasive surgical interventions have the potential advantage of having decreased intra-operative and postoperative complications and morbidity. Patients with multi-level spinal stenosis and spondylolisthesis can be treated with a minimally invasive single-level fusion and adjacent level laminectomy with good results and potentially reduced cost.
Patient Care: Minimally Invasive TLIF surgery is well tolerated in patients. Surgery time, blood loss, length of stay, and pain levels are all decreased in minimally invasive surgery in comparison to the open approach. This research will improve patient care as it provides a more effective method for surgical treatment of back pain.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe minimally invasive TLIF and adjacent level laminectomy 2) Discuss, in small groups, the utility of concomitant adjacent-level laminectomy in these patients, and 3) Identify future effective treatments for lumbar spondylolisthesis with associated adjacent level stenosis.