Introduction: Low back pain is one of the most common reasons patients present to primary care physicians. Many of these patients have spinal stenosis and spondylolisthesis, often treated with open pedicle screw fixation and posterolateral fusion along with decompression. This can be associated with significant morbidity. This study is a retrospective chart review that evaluates patient outcome scores and success rates associated with a minimally invasive one-level spinal fusion and adjacent level laminectomy in this cohort of patients.
Methods: 225 patients presented to our clinic with intractable neurogenic claudication and low back pain with lumbar stenosis and spondylolisthesis. Visual Analog Scale (VAS), Short Form-36 Mental (MCS) and Physical (PCS) Component, and Oswestry Disability Index (ODI) scores were analyzed preoperatively and postoperatively at two, six, twelve, and twenty-four months. Fusion rates were also determined through an independent assessment of dynamic radiographs.
Results: Patients underwent single-level minimally invasive transforaminal lumbar interbody fusion (MITLIF) with or without adjacent level laminectomy. At 24 months, postoperative scores of VAS, ODI, SF-36 MCS, and PCS improved from preoperative baseline by 43.5%, 40.1%, 13.2%, and 21.2%, respectively; improvements at all time points were statistically significant (p <.01). A high radiological fusion rate of 98.2% was recorded, with a mean time to fusion of 6.9 months. Mean blood loss was 125.9ml, with a mean operative time of 178.7min. Average postoperative hospital stay was 4.13 days.
Conclusions: Minimally invasive surgical interventions have the advantage of decreased intraoperative 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 positive results, improved fusion rate, faster healing, and potentially reduced cost.
Patient Care: This study demonstrates that the muscle-sparing minimally invasive approach to treating spondylolisthesis is effective and safe. With statistically significant improvements in the VAS, ODI, and SF-36 outcome scores, as well as radiographic fusion rates, this study supports the use of minimally invasive TLIF and adjacent level MIS laminectomy.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Understand the use of minimally invasive fusion with adjacent level laminectomy in treating spondylolisthesis.
2) Describe the postoperative outcomes associated with this technique.
3) Compare and contrast minimally invasive surgery with traditional open approach.