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  • The effects of surgical level on clinical outcomes following minimally invasive transforaminal lumbar interbody fusion: L4-L5 vs. L5-S1

    Final Number:

    Zachary Adam Smith MD; Cort D. Lawton B.A; Richard G. Fessler MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: TLIF was developed to achieve circumferential fusion of the lumbar spine, similar to the anterior lumbar interbody fusion and posterior lumbar interbody fusion techniques, with the advantage of a reduced risk of complication. Recent advancements in minimally invasive surgery led to the development of MI-TLIF, which has been reported to reduce intra-operative blood loss, post-operative pain, a nd hospitalization.

    Methods: Thirty-six patients with lumbar spinal instability, spondylolisthesis, or degenerative disc disease underwent MI-TLIF. Before surgery and at follow- up, patients completed the Oswestry Disability Index and Visual Analogue Scale for their back and leg, with o utcomes compared between patients with L4- L5 involvement to those with L5-S1 involvement.

    Results: The L4-L5 pathology affected an older age group with a mean age of 63.63 ±10.75 compared to 53.23 ±13.31 for the L5-S1 pathology (p-value = 0.014). The mean hospital stay, operating time, intra-operative blood loss, and hospitalization were not significantly different between the two groups (p-values = 0.587, 0.937, 0.627, 0.587). The post-operative questionnaire results s how no significant difference between the two groups (p-value = 0.819 for VAS [back], p-value = 0.626 for VAS [leg], and p-value = 0.962 for ODI). Two complications included the development of a rash from an antibiotic and a case of post-operative nausea which resolved with discontinuation of narcotic analgesia.

    Conclusions: There is no difference between the outcomes for patients undertaking MI-TLIF at the L4-L5 level compared to the L5-S1 level.

    Patient Care: It will help surgeons to determine the most effective and safe approach to patient's with degenerative lumbar spinal disease at these two common surgical levels.

    Learning Objectives: 1. To determine if the level of operation, a common consideration for open approaches, is important for minimally invasive approaches to the lumbar spine.

    References: 1. Enker P, Steffee AD: Inte rbody fusion and instrumentation. C linical orthopaedics and related research 1994 :90-101. 2. Mummaneni PV, Rodts GE, Jr.: The mini-open transforaminal lumbar interbody fusion. Neurosurgery 2005, 57:256-261; discussion 256-261. 3. Rosenberg WS, Mummaneni P V: Transforaminal lumbar interbody fusion: technique, complications, and early results. Neurosurgery 2001, 48:569-574; discussion 574-565. 4. Dhall SS, Wang MY, Mummaneni P V: Clinical and radiographic comparison of mini- open transforaminal lumbar inte rbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-te rm follow-up. Journal of neurosurgery Spine 2008, 9:560-565. 5. Schwender JD, Holly LT, Rouben DP, Foley KT: Minimally invasive transforaminal lumbar inte rbody fusion (TLIF): technical feasibility and initial results. Journal of spinal disorders & techniques 2005, 18 Suppl:S1-6. 6. Holly LT, Schwender JD, Rouben DP, Foley KT: Minimally invasive transforaminal lumbar inte rbody fusion: indications, technique, and complications. Neurosurgical focus 2006, 20:E6.

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