title: Five-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion: a matched-pair comparison study.
abstract: METHODS
  Retrospective analysis of prospectively collected data.
  
  
  OBJECTIVE
  To compare midterm clinical and radiological outcomes of minimally invasive surgery (MIS) versus open transforaminal lumbar interbody fusion (TLIF).
  
  
  BACKGROUND
  Open TLIF is a proven technique to achieve fusion in symptomatic spinal deformities and instabilities. The possible advantages of MIS TLIF include reduced blood loss, less pain, and shorter hospitalization. To date, there is no published data comparing their midterm outcomes.
  
  
  METHODS
  From 2004-2007, 40 cases of open TLIF were matched paired with 40 cases of MIS TLIF for age, sex, body mass index, and the levels on which the spine was operated. Oswestry Disability Index, neurogenic symptom score, the 36-Item Short Form Health Survey, and visual analogue scale scores for back and leg pain were obtained before surgery, 6 months, 2 years, and 5 years after surgery. Fusion rates were assessed using Bridwell classification.
  
  
  RESULTS
  Fluoroscopic time (MIS: 55.2 s, open: 16.4 s, P < 0.001) was longer in MIS cases. Operative time (MIS: 185 min, open: 166 min, P = 0.085) was not significantly longer in MIS cases. MIS had less blood loss (127 mL) versus open (405 mL, P < 0.001) procedures. Morphine use for MIS cases (8.5 mg) was less compared with open (24.2 mg, P = 0.006). Patients who underwent MIS (1.5 d) ambulated earlier than those who underwent open fusion (3 d, P < 0.001). Patients who underwent MIS (3.6 d) had shorter hospitalization than those who underwent open fusion (5.9 d, P < 0.001). Both groups showed significant improvement in Oswestry Disability Index, neurogenic symptom score, back and leg pain, SF-36 scores at 6 months until 5 years with no significant differences between them. Grade 1 fusion was achieved in 97.5% of both groups at 5 years. The overall complication rate was 20% for the open group and 15% for MIS group (P = 0.774), including 4 cases of adjacent segment disease for each group.
  
  
  CONCLUSIONS
  MIS TLIF is comparable with open TLIF in terms of midterm clinical outcomes and fusion rates with the additional benefits of less initial postoperative pain, less blood loss, earlier rehabilitation, and shorter hospitalization.
authors: From the Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors: Chusheng
authors: C
authors: Seng
authors: Mashfiqul A
authors: MA
authors: Siddiqui
authors: Kenneth P L
authors: KP
authors: Wong
authors: Karen
authors: K
authors: Zhang
authors: William
authors: W
authors: Yeo
authors: Seang Beng
authors: SB
authors: Tan
authors: Wai-Mun
authors: WM
authors: Yue
mesh_terms: D016063:Blood Loss, Surgical; D004185:Disability Evaluation; D004434:Early Ambulation; D005260:Female; D006801:Humans; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009460:Neurologic Examination; D061646:Operative Time; D059408:Pain Management; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control; D011859:Radiography; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome