nach oben

International Orthopaedics

Erschienen in:

01.04.2014 | Original Paper

Comparison of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease

verfasst von: Guangfei Gu, Hailong Zhang, Guoxin Fan, Shisheng He, Xiaobing Cai, Xiaolong Shen, Xiaofei Guan, Xu Zhou

Erschienen in: International Orthopaedics | Ausgabe 4/2014

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The purpose of this study was to compare the clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease.

Methods

We conducted a prospective cohort study of 82 patients, who underwent two-level minimally invasive or open transforaminal lumbar interbody fusion (TLIF) from March 2010 to December 2011. Forty-four patients underwent minimally invasive transforaminal lumbar interbody fusion (MITLIF) (group A) and 38 patients underwent the traditional open TLIF (group B). Demographic data and clinical characteristics were comparable between the two groups before surgery (p > 0.05). Peri-operative data, clinical and radiological outcomes between the two groups were compared.

Results

The mean follow-up period was 20.6 ± 4.5 months for group A and 20.0 ± 3.3 months for group B (p > 0.05). No significant difference existed in operating time between the two group (p > 0.05). X-ray exposure time was significantly longer for MITLIF compared to open cases. Intra-operative blood loss and duration of postoperatively hospital stay of group A were significantly superior to those of group B (p < 0.05). On postoperative day three, MITLIF patients had significantly less pain compared to patients with the open procedure. No statistical difference existed in pre-operative and latest VAS value of back pain (VAS-BP) and leg pain (VAS-LP), pre-operative and latest ODI between the two groups. The fusion rate of the two groups was similar (p < 0.05). Complications included small dural tear, superficial wound infection and overlong screws. When comparing the total complications, no significant difference existed between the groups (p > 0.05).

Conclusions

MITLIF offers several potential advantages including postoperative back pain and leg pain, intra-operative blood loss, transfusion and duration of hospital stay postoperatively in treating two-level lumbar degenerative disease. However, it required much more radiation exposure.

Sethi A, Lee S, Vaidya R (2009) Transforaminal lumbar interbody fusion using unilateral pedicle screws and a translaminar screw. Eur Spine J 18:430–434PubMedCentralPubMedCrossRef

Lee KH, Yue WM, Yeo W, Soeharno H, Tan SB (2012) Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J 21:2265–2270PubMedCentralPubMedCrossRef

Lowe TG, Tahernia AD, O'Brien MF, Smith DA (2002) Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2-year results. J Spinal Disord Tech 15:31–38PubMedCrossRef

Rosenberg WS, Mummaneni PV (2001) Transforaminal lumbar interbody fusion: technique, complications, and early results. Neurosurgery 48:569–574, discussion 574–575PubMedCrossRef

Foley KT, Lefkowitz MA (2002) Advances in minimally invasive spine surgery. Clin Neurosurg 49:499–517PubMed

Schwender JD, Holly LT, Rouben DP, Foley KT (2005) Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech 18:S1–6PubMedCrossRef

Peng CW, Yue WM, Poh SY, Yeo W, Tan SB (2009) Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine 34:1385–1389PubMedCrossRef

Villavicencio AT, Burneikiene S, Roeca CM, Nelson EL, Mason A (2010) Minimally invasive versus open transforaminal lumbar interbody fusion. Surg Neurol Int 1:12PubMedCentralPubMedCrossRef

Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J (2010) Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J 19:1780–1784PubMedCentralPubMedCrossRef

10.

Shunwu F, Xing Z, Fengdong Z, Xiangqian F (2010) Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine 35:1615–1620PubMedCrossRef

11.

Kai Z, Wei S, Chang-Qing Z, Hua L, Wei D, You-Zhuan X, Xiao-Jiang S, Jie Z (2013) Unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in two-level degenerative lumbar disorders: a prospective randomised study. Int Orthop 2013 Aug 6. [Epub ahead of print]

12.

Gu G, Zhang H, He S, Jia J, Fu Q, Zhou X (2013) Preoperative localization methods for minimally invasive surgery in lumbar spine: comparisons between a novel method and conventional methods. J Spinal Disord Tech 26:E277-277E280

13.

Yucesoy K, Yuksel KZ, Baek S, Sonntag VK, Crawford NR (2008) Biomechanics of unilateral compared with bilateral lumbar pedicle screw fixation for stabilization of unilateral vertebral disease. J Neurosurg Spine 8:44–51PubMedCrossRef

14.

Potter BK, Freedman BA, Verwiebe EG, Hall JM, Polly DW Jr, Kuklo TR (2005) Transforaminal lumbar interbody fusion: clinical and radiographic results and complications in 100 consecutive patients. J Spinal Disord Tech 18:337–346PubMedCrossRef

15.

Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K (1995) Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects. Spine 20:1410–1418PubMed

16.

Harms J, Rolinger H (1982) A one-stager procedure in operative treatment of spondylolistheses: dorsal traction-reposition and anterior fusion (author's transl). Z Orthop Ihre Grenzgeb 120:343–347PubMedCrossRef

17.

Blume HG (1985) Unilateral posterior lumbar interbody fusion: simplified dowel technique. Clin Orthop Relat Res 193:75–84

18.

Harms JG, Jeszenszky D (1998) In Process Citation. Oper Orthop Traumatol 10:90–102PubMedCrossRef

19.

Taneichi H, Suda K, Kajino T, Matsumura A, Moridaira H, Kaneda K (2006) Unilateral transforaminal lumbar interbody fusion and bilateral anterior-column fixation with two Brantigan I/F cages per level: clinical outcomes during a minimum 2-year follow-up period. J Neurosurg Spine 4:198–205PubMedCrossRef

20.

Branch CL Jr (1996) The case for posterior lumbar interbody fusion. Clin Neurosurg 43:252–267PubMed

21.

DiPaola CP, Molinari RW (2008) Posterior lumbar interbody fusion. J Am Acad Orthop Surg 16:130–139PubMed

22.

German JW, Foley KT (2005) Minimal access surgical techniques in the management of the painful lumbar motion segment. Spine 30:S52–59PubMedCrossRef

23.

Xiao Y, Li F, Chen Q (2010) Transforaminal lumbar interbody fusion with one cage and excised local bone. Arch Orthop Trauma Surg 130:591–597PubMedCrossRef

24.

Gejo R, Matsui H, Kawaguchi Y, Ishihara H, Tsuji H (1999) Serial changes in trunk muscle performance after posterior lumbar surgery. Spine 24:1023–1028PubMedCrossRef

25.

Sihvonen T, Herno A, Paljarvi L, Airaksinen O, Partanen J, Tapaninaho A (1993) Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 18:575–581PubMedCrossRef

26.

Weber BR, Grob D, Dvorak J, Muntener M (1997) Posterior surgical approach to the lumbar spine and its effect on the multifidus muscle. Spine 22:1765–1772PubMedCrossRef

27.

Schizas C, Tzinieris N, Tsiridis E, Kosmopoulos V (2009) Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience. Int Orthop 33:1683–1688PubMedCentralPubMedCrossRef

28.

Foley KT, Holly LT, Schwender JD (2003) Minimally invasive lumbar fusion. Spine 28:S26–35PubMed

29.

Min S, Hwang S (2009) Minimal invasive unilateral transforaminal lumbar interbody fusion by sublaminar decompression - comparison to bilateral approach. J Korean Orthop Assoc 44:7682

30.

Min S, Lee D (2009) Minimally invasive transforaminal lumbar interbody fusion in patients with low grade spondylolisthesis - comparison of the unilateral and bilateral approaches. J Korean Orthop Assoc 44:429435

31.

Klein LW, Miller DL, Balter S, Laskey W, Haines D, Norbash A, Mauro MA, Goldstein JA (2009) Occupational health hazards in the interventional laboratory: time for a safer environment. Radiology 250:538–544PubMedCrossRef

32.

Brenner DJ, Doll R, Goodhead DT, Hall EJ, Land CE, Little JB, Lubin JH, Preston DL, Preston RJ, Puskin JS, Ron E, Sachs RK, Samet JM, Setlow RB, Zaider M (2003) Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA 100:13761–13766PubMedCentralPubMedCrossRef

33.

Thorne MC (2012) Regulating exposure of the lens of the eye to ionising radiations. J Radiol Prot 32:147–154PubMedCrossRef

Titel: Comparison of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease
verfasst von: Guangfei Gu
Hailong Zhang
Guoxin Fan
Shisheng He
Xiaobing Cai
Xiaolong Shen
Xiaofei Guan
Xu Zhou
Publikationsdatum: 01.04.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: International Orthopaedics / Ausgabe 4/2014
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-013-2169-x

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Aquatherapie bei Fibromyalgie wirksamer als Trockenübungen

03.05.2024 Fibromyalgiesyndrom Nachrichten

Bewegungs-, Dehnungs- und Entspannungsübungen im Wasser lindern die Beschwerden von Patientinnen mit Fibromyalgie besser als das Üben auf trockenem Land. Das geht aus einer spanisch-brasilianischen Vergleichsstudie hervor.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärzte und Psychotherapeuten.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders scheint das auf weibliche Kranke zuzutreffen, wie eine Studie zeigt.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Chronische Unterbauch- und Viszeralschmerzen in der Praxis managen"

Springer Medizin

Comparison of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease