title: A novel minimally invasive technique for lumbar decompression, realignment, and navigated interbody fusion.
abstract: We present a novel, minimally invasive, navigation-guided approach for surgical treatment of degenerative spondylolisthesis (DS) that is a hybrid of the two most common techniques, posterior interbody fusion (PLIF) and transforaminal interbody fusion (TLIF). DS is an acquired condition with intersegmental instability of one or more lumbar motion segments. Seven patients with single level lumbar DS underwent lumbar arthrodesis utilizing the hybrid technique (HLIF) in our center. Using a standard unilateral midline approach a decompression and partial facetectomy on one side was performed, allowing for implantation of a specially designed interbody cage. Pedicle screws were placed using neuronavigation in a vertical vector on the side of the partial facetectomy and dorsolaterally (percutaneous) on the contralateral side. Patient and operative data, numeric rating scale (NRS) pain scores, core outcome measures index (COMI) and Oswestry disability index (ODI) were recorded preoperatively as well as 6 weeks, 3 months, 6 months and 1 year after surgery. All patients completed the 1 year follow-up. There was significant postoperative improvement of NRS, COMI and ODI scores at all postoperative follow-up time points (p<0.05). The radiological assessments of realignment showed a reduction of listhesis from an average of 21.04% (standard deviation [SD] 5.1) preoperatively to 9.14% (SD 4.0) postoperatively (p<0.001). The average blood loss was 492 ml. Post-procedure CT scans demonstrated correct implant placement in all but one patient who required a revision of a single pedicle screw. HLIF allows thorough decompression as well as realignment and interbody fusion for patients with DS and may help reduce tissue trauma in comparison to other minimally invasive lumbar fusion techniques.
authors.affiliation: Department of General Neurosurgery, University of Cologne, Kerpener Straße 62, Cologne 50937, Germany; Molecular Neurotherapy and Imaging Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Clemens
authors.initials: C
authors.lastname: Reinshagen
authors.affiliation: Department of General Neurosurgery, University of Cologne, Kerpener Straße 62, Cologne 50937, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ruess
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Walcott
authors.affiliation: Department of General Neurosurgery, University of Cologne, Kerpener Straße 62, Cologne 50937, Germany; Institute of Neurophysiology, Medical Faculty, University of Cologne, Cologne, Germany.
authors.forename: Marek
authors.initials: M
authors.lastname: Molcanyi
authors.affiliation: Department of General Neurosurgery, University of Cologne, Kerpener Straße 62, Cologne 50937, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Goldbrunner
authors.affiliation: Department of General Neurosurgery, University of Cologne, Kerpener Straße 62, Cologne 50937, Germany; Department of Neurosurgery, University of Dresden, Fetscher Straße 74, Dresden, Germany. Electronic address: bernhard.rieger.com@gmail.com.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Rieger
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D065289:Pedicle Screws; D013123:Spinal Fusion / Q000379:methods*; D013168:Spondylolisthesis / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Degenerative spondylolisthesis; Interbody; Lumbar fusion; Minimally invasive