title: Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2.
abstract: Minimally invasive lumbar fusion techniques have only recently been developed. The goals of these procedures are to reduce approach-related soft tissue injury, postoperative pain and disability while allowing the surgery to be conducted in an effective manner. There have been no prospective clinical reports published on the comparison of one-level transforaminal lumbar interbody fusion in low-grade spondylolisthesis performed with an independent blade retractor system or a traditional open approach. A prospective clinical study of 85 consecutive cases of degenerative and isthmic lower grade spondylolisthesis treated by minimally invasive transforaminal lumbar interbody fusion (MiTLIF) or open transforaminal lumbar interbody fusion (OTLIF) was done. A total of 85 patients suffering from degenerative spondylolisthesis (n = 46) and isthmic spondylolisthesis (n = 39) underwent one-level MiTLIF (n = 42) and OTLIF (n = 43) by two experienced surgeons at one hospital, from June 2006 to March 2008 (minimum 13-month follow-up). The following data were compared between the two groups: the clinical and radiographic results, operative time, blood loss, transfusion needs, X-ray exposure time, postoperative back pain, length of hospital stay, and complications. Clinical outcome was assessed using the visual analog scale (VAS) and the Oswestry disability index. The operative time, clinical and radiographic results were basically identical in both groups. Comparing with the OTLIF group, the MiTLIF group had significantly lesser blood loss, lesser need for transfusion, lesser postoperative back pain, and shorter length of hospital stay. The radiation time was significantly longer in MiTLIF group. One case of nonunion was observed from each group. Minimally invasive TLIF has similar surgical efficacy with the traditional open TLIF in treating one-level lower grade degenerative or isthmic spondylolisthesis. The minimally invasive technique offers several potential advantages including smaller incisions, less tissue trauma and quicker recovery. However, this technique needs longer X-ray exposure time.
authors.affiliation: Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, The Third Military Medical University, No 2, Xinqiao Street, Shapingba District, Chongqing 400037, People's Republic of China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhou
authors.forename: Zheng Feng
authors.initials: ZF
authors.lastname: Zhang
authors.forename: Chang Qing
authors.initials: CQ
authors.lastname: Li
authors.forename: Wen Jie
authors.initials: WJ
authors.lastname: Zheng
authors.forename: Jie
authors.initials: J
authors.lastname: Liu
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D011446:Prospective Studies; D011859:Radiography; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*
references.citation: Spine (Phila Pa 1976). 1993 Apr;18(5):575-81
references.pmid: 8484148
references.citation: Spine (Phila Pa 1976). 1994 Nov 15;19(22):2598-602
references.pmid: 7855687
references.citation: J Neurosurg Spine. 2005 Aug;3(2):98-105
references.pmid: 16370298
references.citation: Clin Orthop Relat Res. 1988 Feb;227:99-102
references.pmid: 3338227
references.citation: Spine (Phila Pa 1976). 1996 Apr 15;21(8):941-4
references.pmid: 8726197
references.citation: Spine (Phila Pa 1976). 2001 Mar 1;26(5):567-71
references.pmid: 11242386
references.citation: J Neurosurg. 1953 Mar;10(2):154-68
references.pmid: 13035484
references.citation: Neurosurgery. 2007 Apr;60(4 Suppl 2):203-12; discussion 212-3
references.pmid: 17415155
references.citation: Eur Spine J. 2005 Nov;14(9):887-94
references.pmid: 16151713
references.citation: J Spinal Disord Tech. 2005 Feb;18 Suppl:S1-6
references.pmid: 15699793
references.citation: Clin Sports Med. 1993 Jan;12(1):143-50
references.pmid: 8418975
references.citation: Int Orthop. 2009 Dec;33(6):1683-8
references.pmid: 19023571
references.citation: Spine (Phila Pa 1976). 1998 Feb 1;23(3):354-8
references.pmid: 9507625
references.citation: Best Pract Res Clin Rheumatol. 2002 Jan;16(1):123-40
references.pmid: 11987935
references.citation: Neurosurgery. 2006 Oct;59(4 Suppl 2):ONS361-6; discussion ONS366-7
references.pmid: 17041505
references.citation: Neurosurgery. 2005 Oct;57(4 Suppl):256-61; discussion 256-61
references.pmid: 16234672