In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

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

    Final Number:
    1469

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

    Study Design:
    Other

    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.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy