Minimally Invasive Cost-Effective Surgical Treatment of Lumbar Spondylolisthesis with Associated Spinal Stenosis

Introduction: The minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) was developed as an alternative to the traditional open transforaminal lumbar interbody fusion (TLIF). The paraspinal approach and muscle sparing nature of the MI-TLIF are thought to decrease operative morbidity while improving patient recovery and long-term outcomes.

Methods: Data was reviewed for 19 patients who underwent a novel MI-TLIF compared to 140 patients undergoing tradition open midline TLIF approach for the treatment of lumbar spondylolisthesis with associated stenosis as part of an FDA control trial group. Operative and demographic data were collected including age, gender, BMI, comorbidities, operative level, procedure time, estimated blood loss, postoperative length of stay. Pre and postoperative patient reported outcome scores including visual analogue score (VAS) for back and leg/hip pain and Oswestry disability index (ODI) were collected.

Results: Pre-operative and two-year follow up VAS for back and leg/hip pain and ODI scores were collected for the novel and traditional TLIF patients. The procedure time, estimated blood loss (EBL) and length of hospital stay (days) for MI-TLIF were 156 +/- 31, 72 +/- 32, and 2.6 +/- 1.8, respectively. Compared to traditional TLIF procedure time, estimated blood loss, and length of hospital stay of 189 +/- 78, 273 +/- 252, 3.1 +/- 1.7, respectively. VAS back and leg/hip pre-operatively were 79.3, 85.3, and 52.2 versus 20.6, 20.3 and 16.9 points, respectively at 2-year follow-up for MI-TLIF. Compared to 69.7, 78.8, and 52.7 versus 27.9, 27.8 and 22.4 at 2-year follow-up for traditional midline TLIF. These improvements were all statistically significant at the 5% level.

Conclusion : The MI-TLIF compared to traditional TLIF described in this paper resulted in shorter operative time, less EBL, and shorter length of stay. In addition, the novel MI-TLIF resulted in better improvements in patient reported functional outcomes. This novel MI-TLIF technique is an excellent surgical treatment for refractory lumbar spondylolisthesis with associated stenosis.