Minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases in elderly

English Keywords:Transforaminal lumbar interbody fusion  Minimally invasive  Degenerative lumbar diseases  Elderly

English Abstract:

  【Abstract】 Objectives: To evaluate outcomes of posterior transforaminal lumbar interbody fusion(MI-TLIF) under Pipeline expandable access system for lumbar degenerative diseases in elderly. Methods: From February 2010 to June 2012, 46 elderly patients with lumbar degenerative diseases who underwent TLIF by using two different approaches were retrospectively analyzed. All patients were classified into observation group(MI-TLIF group) and control group(conventional open TLIF, CO-TLIF) according to the operative methods. There were 24 cases in observation group including 15 males and 9 females, aged from 60 to 79 years(average, 66.3 years), and the course of diseases ranging from 6 to 60 months(average, 18.5 months); 22 cases in control group including 10 males and 12 females, aged from 62 to 75 years(average, 67.0 years), and course of diseases ranging from 8 to 64 months(average, 22.6 months). The blood loss, operation time, amount of blood transfusion and postoperative complications were compared. The clinical outcomes of both groups were evaluated by using the VAS(at postoperative 1 week, 3 months and the final follow-up) and ODI(at postoperative 3 months and the final follow-up), respectively. The bony fusion of both groups were assessed by the Suk standard at the final follow-up. Results: There were significant differences on blood loss, amount of blood transfusion and postoperative complications(P＜0.05), but no significant difference on operation time between MI-TLIF group and control group(P>0.05). All patients were followed up for an average of 18 months(range, 13 to 26 months). The VAS and ODI of both groups at each time point postoperatively experienced improvement compared with the preoperation(P＜0.05). There were significant differences on VAS score at 1 week and 3 months and the ODI at 3 months respectively, but no differences was noted at the final follow-up between 2 groups(P＜0.05). The bony fusion rate of MI-TLIF group and control group was 87.5%(21/23 cases) and 82.8%(18/22 cases) at the final follow-up respectively, which showed no statistical significance(P＞0.05). Conclusions: MI-TLIF has similar surgical outcome with CO-TLIF for lumbar degenerative diseases in elderly, but the former has less blood loss and complications than the latter.