15 - Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison...

#15 Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Two Techniques

MIS Techniques and Outcomes

Poster Presented by: G.C. Tender

Author(s):

G.C. Tender (1)

(1) Louisiana State University in New Orleans, Neurosurgery, New Orleans, LA, United States

Abstract

Background: Minimally invasive transforaminal lumbar interbody fusion (MI TLIF) is likely to become the most frequently performed spine operation in the United States. Two conceptually different MI TLIF techniques can be used, one based on tubular retraction and decompression, the other based on retractors attached to the pedicle screws.

Materials and Methods: A total of 60 patients underwent an MI TLIF between Jan 2009 and June 2012, using the tubular technique in 43 patients and the screw-based-retractor technique in the remaining 17 patients. The perioperative parameters and the clinical and radiographic outcomes at 1-year postoperatively were retrospectively reviewed.

Results: In the 43 patients undergoing MI TLIF using the tubular technique, the average operative time was 189 min (range: 135-290) and the average estimated blood loss was 170 (range: 50 - 500). The length of hospital stay was 3.37 days (range: 1 -7). The visual analog scale (VAS) score improved from 9.7 (range: 8 - 10) preoperatively to 2.6 (range: 1 - 10) postoperatively at 1 year. There were two incidental durotomies, none resulting in a cerebrospinal fluid leak. There was one re-intervention for removal of a misplaced pedicle screw. One patient had a postoperative superficial wound infection that resolved with antibiotic treatment alone.

In the 17 patients undergoing MI TLIF using the screw-based-retractor technique, the average operative time was 223 min (range: 129 - 354) and the average estimated blood loss was 257 ml (range: 50 - 600). The length of hospital stay was 3.29 days (range: 2-8). The visual analog scale (VAS) score improved from 9.4 (range: 8 - 10) preoperatively to 1.9 (range: 1 - 8) postoperatively at 1 year. One patient who had an incidental durotomy developed a postoperative compressive hematoma with resultant cauda equina syndrome requiring re-intervention; she did not present for the follow-up visit. There were no re-interventions for revision of instrumentation.

Seven patients were lost at the 1-year follow-up visit (4 in the tubular technique, 3 in the screw-based-retractor technique). The fusion rate at 1 year was 100% in the followed patients.

Conclusions: Both MI TLIF techniques can be used with good results, but each technique offers distinct advantages and challenges. Spine surgeons embracing the minimally invasive techniques should be familiar with both the tubular retractor and pedicle screw-based-retractor techniques.