title: Minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis and degenerative spondylosis: 5-year results.
abstract: BACKGROUND
  Multiple studies have reported favorable short-term results after treatment of spondylolisthesis and other degenerative lumbar diseases with minimally invasive transforaminal lumbar interbody fusion. However, to our knowledge, results at a minimum of 5 years have not been reported.
  
  
  OBJECTIVE
  We determined (1) changes to the Oswestry Disability Index, (2) frequency of radiographic fusion, (3) complications and reoperations, and (4) the learning curve associated with minimally invasive transforaminal lumbar interbody fusion at minimum 5-year followup.
  
  
  METHODS
  We reviewed our first 124 patients who underwent minimally invasive transforaminal lumbar interbody fusion to treat low-grade spondylolisthesis and degenerative lumbar diseases and did not need a major deformity correction. This represented 63% (124 of 198) of the transforaminal lumbar interbody fusion procedures we performed for those indications during the study period (2003-2007). Eighty-three (67%) patients had complete 5-year followup. Plain radiographs and CT scans were evaluated by two reviewers. Trends of surgical time, blood loss, and hospital stay over time were examined by logarithmic curve fit-regression analysis to evaluate the learning curve.
  
  
  RESULTS
  At 5 years, mean Oswestry Disability Index improved from 60 points preoperatively to 24 points and 79 of 83 patients (95%) had improvement of greater than 10 points. At 5 years, 67 of 83 (81%) achieved radiographic fusion, including 64 of 72 patients (89%) who had single-level surgery. Perioperative complications occurred in 11 of 124 patients (9%), and another surgical procedure was performed in eight of 124 patients (6.5%) involving the index level and seven of 124 patients (5.6%) at adjacent levels. There were slowly decreasing trends of surgical time and hospital stay only in single-level surgery and almost no change in intraoperative blood loss over time, suggesting a challenging learning curve.
  
  
  CONCLUSIONS
  Oswestry Disability Index scores improved for patients with spondylolisthesis and degenerative lumbar diseases treated with minimally invasive transforaminal lumbar interbody fusion at minimum 5-year followup. We suggest this procedure is reasonable for properly selected patients with these indications; however, traditional approaches should still be performed for patients with high-grade spondylolisthesis, patients with a severely collapsed disc space and no motion seen on the dynamic radiographs, patients who need multilevel decompression and arthrodesis, and patients with kyphoscoliosis needing correction.
  
  
  METHODS
  Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
authors: Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Yonsei University College of Medicine, 1232, Baeksok Street, Ilsan District, Goyang City, Gyeonggi Province, 410-719, Republic of Korea, yungspine@gmail.com.
authors: Yung
authors: Y
authors: Park
authors: Joong Won
authors: JW
authors: Ha
authors: Yun Tae
authors: YT
authors: Lee
authors: Na Young
authors: NY
authors: Sung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D010147:Pain Measurement; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013168:Spondylolisthesis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D055009:Spondylosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
references: Spine (Phila Pa 1976). 2004 Sep 1;29(17):1938-44
references: 15534420
references: Neurosurg Focus. 2006 Mar 15;20(3):E6
references: 16599422
references: J Neurosurg Spine. 2008 Dec;9(6):560-5
references: 19035748
references: Spine (Phila Pa 1976). 2007 Mar 1;32(5):537-43
references: 17334287
references: Spine J. 2007 Sep-Oct;7(5):541-6
references: 17448732
references: Neurosurgery. 2007 Apr;60(4 Suppl 2):203-12; discussion 212-3
references: 17415155
references: Neurosurg Focus. 2008;25(2):E16
references: 18673045
references: Spine (Phila Pa 1976). 2003 Aug 1;28(15 Suppl):S26-35
references: 12897471
references: J Bone Joint Surg Am. 1991 Jul;73(6):802-8
references: 2071615
references: Spine (Phila Pa 1976). 2009 Jun 1;34(13):1385-9
references: 19478658
references: Int Orthop. 2009 Dec;33(6):1683-8
references: 19023571
references: Spine (Phila Pa 1976). 1995 Jun 15;20(12):1410-8
references: 7676341
references: Spine (Phila Pa 1976). 2010 Aug 1;35(17):1615-20
references: 20479702
references: Spine J. 2011 Mar;11(3):205-12
references: 21377602
references: Spine (Phila Pa 1976). 1997 Dec 15;22(24):2807-12
references: 9431616
references: Neurosurg Focus. 2006 Mar 15;20(3):E10
references: 16599416
references: J Bone Joint Surg Am. 2009 Jun;91(6):1295-304
references: 19487505
references: Spine (Phila Pa 1976). 2012 Aug 15;37(18):1548-57
references: 22426447
references: Physiotherapy. 1980 Aug;66(8):271-3
references: 6450426
references: J Spinal Disord Tech. 2011 Jul;24(5):288-96
references: 20975594
references: J Spinal Disord Tech. 2005 Feb;18 Suppl:S1-6
references: 15699793
references: J Neurosurg Spine. 2012 Jan;16(1):44-50
references: 21999389
references: Spine (Phila Pa 1976). 2004 Apr 1;29(7):726-33; discussion 733-4
references: 15087793
references: J Spinal Disord. 2001 Apr;14(2):100-3
references: 11285420
references: Eur Spine J. 2003 Feb;12(1):12-20
references: 12592542
references: Eur Spine J. 2005 Aug;14(6):551-8
references: 15672243
references: J Spinal Disord. 2001 Dec;14(6):533-40
references: 11723406