Journal List > J Korean Orthop Assoc > v.44(4) > 1012924

Min and Lee: Minimally Invasive Transforaminal Lumbar Interbody Fusion in Patients with Low Grade Spondylolisthesis - Comparison of the Unilateral and Bilateral Approaches -

Abstract

Purpose

We wanted to analyze the clinical and radiological results of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in patients with low grade spondylolisthesis, and we also compared the unilateral and bilateral approaches.

Materials and Methods

This study examined a consecutive series of 27 patients who underwent one-level MI-TLIF (16 cases of the unilateral approach and 11 cases of the bilateral approach) and the follow-up data was compared with a minimum 1-year follow-up. The amount of intraoperative blood loss, the postoperative drainage, the transfusion requirement and the surgery time were investigated. The clinical outcomes were analyzed using the visual analogue scale (VAS), the Oswestry disability index (ODI) and the SF-36 Physical Composite Score (SF-36). The preoperative, postoperative and last follow-up changes in the height of the disc, the degree of the slipping and the slip angle in the fused segments were radiologically analyzed.

Results

There were no significant differences between the two groups in terms of the clinical and radiological results at the last follow-up. But the unilateral approach-group was found to have less blood loss, less postoperative drainage, a lesser requirement for transfusion and a shorter duration of surgery. During the reduction process in 1 patient among the cases that had the unilateral approach used, the pedicle screw fixed to the vertebral body fell out.

Conclusion

The unilateral MI-TLIF can shorten the operation time and reduce the blood loss as compared to the bilateral approa

Figures and Tables

Fig. 1
Lateral fluoroscopic image showing restoration of disc height. (A) Preoperative lateral fluoroscopic image showing spondylolisthesis. (B) A distracting osteotome is used to enter the disc space and obtain enough height to allow placement of the initial distractor, followed by sequentially larger interbody distractors.
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Fig. 2
MI-TLIF procedure with anterolosthesis reduction for grade II spondylolisthesis. (A) Preoperative lateral radiography. (B) Postoperative lateral radiography showing reduction of spondylolisthesis.
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Fig. 3
Lateral fluoroscopic images showing reduction of a spondylolisthesis using the reduction screw extender
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Fig. 4
(A, B) On the reduction of a spondylolisthesis using the reduction screw extender (A), note pull-out of the reduction screw (B). (C) Reduction using reduction screw after cement augmentation.
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Table 1
Classification
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Table 2
Perioperative Data
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Table 3
Clinical Outcomes
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Table 4
Height of the Disc, Percentage of Slipping & Slip Angle
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