Clinical outcome of single-level minimally invasive transforaminal lumbar interbody fusion for lumbar spine spondylolisthesis

English Keywords:Lumbar spondylolisthesis  Minimally invasive surgery  Transforaminal lumbar interbody fusion  Internal fixation

English Abstract:

  【Abstract】　Objective：To evaluate the surgical effect of single-level minimally invasive transforaminal lumbar interbody fusion（MiTLIF） for lumbar spine spondylolisthesis.Method：From January 2007 to March 2010，163 cases（61 males and 102 females） suffering lumbar spine spondylolisthesis underwent MiTLIF.The mean age was 51.6 years（range，37-72 years），and the preoperative pathogenesis included degenerative spondylolisthesis（n=97） and isthmic spondylolisthesis（n=66）.There were 135 grade 1 and 28 grade 2 in terms of spondylolisthesis.The involved levels were 7 L3，86 L4 and 70 L5.One-level transforaminal decompression and intebody fusion with bilateral percutaneous pedicle screw fixation under Quadrant retractor system was performed in all cases.All 163 cases were divided into 3 groups chronologically：group A（N0.1 to 55），group B（N0.56 to 110），group C（NO.111 to 163）.The operative time，X-ray exposure time，blood loss and complications were measured and analyzed.Clinical outcome was assessed using the visual analog scale（VAS） and the Oswestry disability index（ODI）.Fusion rates were assessed using CT scan and 3-dimensional reconstruction.Result：163 patients had an average intraoperative blood loss of 330ml（100-750ml），average postoperative blood loss of 57ml（10-175ml），average operative time of 145min（83-230min），average X-ray exposure time of 59s（27-126s）.The intraoperative blood loss and radiation time in group B decreased significantly compared with group A（P<0.05），and these indexes in group C decreased significantly compared with group A and B（P<0.05）.7 cases were complicated with dural tear，4 in group A，2 in group B and 1 in group C，and all were followed by cerebrospinal fluid leakage at the 2nd day after operation and ceased within 5 days after correspondent intervention.Four patients in group A developed onset nerve root irritation after operation and resolved after endoscopic decompression.91 cases were followed up for a mean of 24.5 months（10-47 months）.The VAS score for preoperative，the 3rd day after surgery and final follow up was 6.8±2.4，1.5±0.6 and 0.8±0.4 respectively，which showed significant difference between postoperative and preoperative ones（P<0.05）.The ODI score for preoperative and final follow up was 39.4±5.1 and 11.3±2.6 respectively，which showed significant difference（P<0.05）.The fusion rate at final follow-up was 96.7%（88/91）.Conclusion：MiTLIF is reliable and effective for grades 1 and 2 lumbar spine spondylolisthesis.