Outcomes and complications of minimally invasive transforaminal lumbar interbody fusion in the elderly: a systematic review and meta-analysis

View More View Less
  • 1 Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

OBJECTIVE

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may be used to treat degenerative spinal pathologies while reducing risks associated with open procedures. As an increasing number of lumbar fusions are performed in the aging United States population, MIS-TLIF has been widely adopted into clinical practice in recent years. However, its complication rate and functional outcomes in elderly patients remain poorly characterized. The objective of this study was to assess complication rates and functional outcomes in elderly patients (≥ 65 years old) undergoing MIS-TLIF.

METHODS

The PubMed, Embase, and Scopus databases were searched for relevant records in accordance with the PRISMA guidelines. Inclusion criteria were peer-reviewed original research; English language; full text available; use of MIS-TLIF; and an elderly cohort of at least 5 patients. Risk of bias was assessed using the ROBINS-I (Risk of Bias in Nonrandomized Studies—of Interventions) tool. Pooled complication rates were calculated for elderly patients, with subgroup analyses performed for single versus multiple-level fusions. Complication rates in elderly compared to nonelderly patients were also assessed. Postoperative changes in patient-reported outcomes, including Oswestry Disability Index (ODI) and visual analog scale (VAS) back pain (BP) and leg pain (LP) scores, were calculated.

RESULTS

Twelve studies were included in the final analysis. Compared to nonelderly patients, MIS-TLIF in elderly patients resulted in significantly higher rates of major (OR 2.15, 95% CI 1.07–4.34) and minor (OR 2.20, 95% CI 1.22–3.95) complications. The pooled major complication rate in elderly patients was 0.05 (95% CI 0.03–0.08) and the pooled minor complication rate was 0.20 (95% CI 0.13–0.30). Single-level MIS-TLIF had lower major and minor complication rates than multilevel MIS-TLIF, although not reaching significance. At a minimum follow-up of 6 months, the postoperative change in ODI (−30.70, 95% CI −41.84 to −19.55), VAS-BP (−3.87, 95% CI −4.97 to −2.77), and VAS-LP (−5.11, 95% CI −6.69 to −3.53) in elderly patients all exceeded the respective minimum clinically important difference. The pooled rate of fusion was 0.86 (95% CI 0.80–0.90).

CONCLUSIONS

MIS-TLIF in elderly patients results in a high rate of fusion and significant improvement of patient-reported outcomes, but has significantly higher complication rates than in nonelderly patients. Limitations of this study include heterogeneity in the definition of elderly and limited reporting of risk factors among included studies. Further study of the impact of complications and the factors predisposing elderly patients to poor outcomes is needed.

ABBREVIATIONS

MCID = minimum clinically important difference; MIS-TLIF = minimally invasive transforaminal lumbar interbody fusion; ODI = Oswestry Disability Index; ROBINS-I = Risk of Bias in Nonrandomized Studies—of Interventions; VAS-BP = visual analog scale for back pain; VAS-LP = visual analog scale for leg pain.

Supplementary Materials

    • Supplementary Figure 1 (PDF 708 KB)

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, et al. The rising prevalence of chronic low back pain. Arch Intern Med. 2009;169(3):251258.

    • Search Google Scholar
    • Export Citation
  • 2

    Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):23562367.

    • Search Google Scholar
    • Export Citation
  • 3

    Lurie JD, Tosteson TD, Tosteson AN, Zhao W, Morgan TS, Abdu WA, et al. Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial. Spine (Phila Pa 1976).2014;39(1):316.

    • Search Google Scholar
    • Export Citation
  • 4

    Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS. Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the united states, 2004 to 2015.Spine (Phila Pa 1976).2019;44(5):369376.

    • Search Google Scholar
    • Export Citation
  • 5

    Kim YH, Ha KY, Rhyu KW, Park HY, Cho CH, Kim HC, et al. Lumbar interbody fusion: techniques, pearls and pitfalls. Asian Spine J. 2020;14(5):730741.

    • Search Google Scholar
    • Export Citation
  • 6

    Lener S, Wipplinger C, Hernandez RN, Hussain I, Kirnaz S, Navarro-Ramirez R, et al. Defining the MIS-TLIF: a systematic review of techniques and technologies used by surgeons worldwide. Global Spine J. 2020;10(2)(suppl):151S167S.

    • Search Google Scholar
    • Export Citation
  • 7

    Park Y, Seok SO, Lee SB, Ha JW. Minimally invasive lumbar spinal fusion is more effective than open fusion: a meta-analysis. Yonsei Med J. 2018;59(4):524538.

    • Search Google Scholar
    • Export Citation
  • 8

    Jin-Tao Q, Yu T, Mei W, Xu-Dong T, Tian-Jian Z, Guo-Hua S, et al. Comparison of MIS vs. open PLIF/TLIF with regard to clinical improvement, fusion rate, and incidence of major complication: a meta-analysis. Eur Spine J. 2015;24(5):10581065.

    • Search Google Scholar
    • Export Citation
  • 9

    Xie L, Wu WJ, Liang Y. Comparison between minimally invasive transforaminal lumbar interbody fusion and conventional open transforaminal lumbar interbody fusion: an updated meta-analysis. Chin Med J (Engl). 2016;129(16):19691986.

    • Search Google Scholar
    • Export Citation
  • 10

    Lee N, Kim KN, Yi S, Ha Y, Shin DA, Yoon DH, Kim KS. Comparison of outcomes of anterior, posterior, and transforaminal lumbar interbody fusion surgery at a single lumbar level with degenerative spinal disease. World Neurosurg. 2017;101:216226.

    • Search Google Scholar
    • Export Citation
  • 11

    Reisener MJ, Pumberger M, Shue J, Girardi FP, Hughes AP. Trends in lumbar spinal fusion—a literature review. J Spine Surg. 2020;6(4):752761.

    • Search Google Scholar
    • Export Citation
  • 12

    Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203(6):865877.

    • Search Google Scholar
    • Export Citation
  • 13

    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.

    • Search Google Scholar
    • Export Citation
  • 14

    Carreon LY, Puno RM, Dimar JR II, Glassman SD, Johnson JR. Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am. 2003;85(11):20892092.

    • Search Google Scholar
    • Export Citation
  • 15

    Weir CJ, Butcher I, Assi V, Lewis SC, Murray GD, Langhorne P, Brady MC. Dealing with missing standard deviation and mean values in meta-analysis of continuous outcomes: a systematic review. BMC Med Res Methodol. 2018;18(1):25.

    • Search Google Scholar
    • Export Citation
  • 16

    Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372(160-n):n160.

    • Search Google Scholar
    • Export Citation
  • 17

    Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.

    • Search Google Scholar
    • Export Citation
  • 18

    Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J. 2008;8(6):968974.

    • Search Google Scholar
    • Export Citation
  • 19

    Parker SL, Adogwa O, Paul AR, Anderson WN, Aaronson O, Cheng JS, McGirt MJ. Utility of minimum clinically important difference in assessing pain, disability, and health state after transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis. J Neurosurg Spine. 2011;14(5):598604.

    • Search Google Scholar
    • Export Citation
  • 20

    Claus CF, Lytle E, Tong D, Bahoura M, Garmo L, Yoon E, et al. Elderly as a predictor for perioperative complications in patients undergoing multilevel minimally invasive transforaminal lumbar interbody fusion: a regression modeling study. Spine (Phila Pa 1976). 2020;45(11):735740.

    • Search Google Scholar
    • Export Citation
  • 21

    Goh GSH, Tay YWA, Liow MHL, Gatot C, Ling ZM, Fong PL, et al. Elderly patients undergoing minimally invasive transforaminal lumbar interbody fusion may have similar clinical outcomes, perioperative complications, and fusion rates as their younger counterparts. Clin Orthop Relat Res. 2020;478(4):822832.

    • Search Google Scholar
    • Export Citation
  • 22

    Lee DY, Jung TG, Lee SH. Single-level instrumented mini-open transforaminal lumbar interbody fusion in elderly patients. J Neurosurg Spine. 2008;9(2):137144.

    • Search Google Scholar
    • Export Citation
  • 23

    Lee HJ, Kim JS, Ryu KS. Minimally invasive TLIF using unilateral approach and single cage at single level in patients over 65. BioMed Res Int. 2016;2016:4679865.

    • Search Google Scholar
    • Export Citation
  • 24

    Lee P, Fessler RG. Perioperative and postoperative complications of single-level minimally invasive transforaminal lumbar interbody fusion in elderly adults. J Clin Neurosci. 2012;19(1):111114.

    • Search Google Scholar
    • Export Citation
  • 25

    Lin GX, Quillo-Olvera J, Jo HJ, Lee HJ, Covarrubias-Rosas CA, Jin C, Kim JS. Minimally invasive transforaminal lumbar interbody fusion: a comparison study based on end plate subsidence and cystic change in individuals older and younger than 65 years. World Neurosurg. 2017;106:174184.

    • Search Google Scholar
    • Export Citation
  • 26

    Nikhil N J, Lim JW, Yeo W, Yue WM. Elderly patients achieving clinical and radiological outcomes comparable with those of younger patients following minimally invasive transforaminal lumbar interbody fusion. Asian Spine J. 2017;11(2):230242.

    • Search Google Scholar
    • Export Citation
  • 27

    Ould-Slimane M, Cantogrel P, Lefèvre E, Parent HF, Gauthé R. Minimally invasive unilateral lumbar interbody fusion (UNILIF) in over-80-year-olds. Continuous series of 42 patients at 1.4 years’ follow-up. Orthop Traumatol Surg Res. 2020;106(2):275279.

    • Search Google Scholar
    • Export Citation
  • 28

    Patel J, Kundnani V, Kuriya S, Raut S, Meena M. Surgical outcomes of minimally invasive transforaminal lumbar interbody fusion in elderly. J Minim Invasive Spine Surg Tech. 2020;5(1):1319.

    • Search Google Scholar
    • Export Citation
  • 29

    Senker W, Stefanits H, Gmeiner M, Trutschnig W, Radl C, Gruber A. The influence of age on the peri- and postoperative clinical course in patients undergoing minimally invasive transforaminal lumbar interbody fusion techniques of the lumbar spine. Clin Neurol Neurosurg. 2019;182:2531.

    • Search Google Scholar
    • Export Citation
  • 30

    Wu WJ, Liang Y, Zhang XK, Cao P, Zheng T. Complications and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion for the treatment of one- or two-level degenerative disc diseases of the lumbar spine in patients older than 65 years. Chin Med J (Engl). 2012;125(14):25052510.

    • Search Google Scholar
    • Export Citation
  • 31

    Yang YS, Hsieh CT, Lin JH, Chiang YH. The incidences of perioperative complications in the elderly following minimally invasive lumbar transforaminal interbody fusion. J Med Sci (Taiwan). 2016;36(5):175179.

    • Search Google Scholar
    • Export Citation
  • 32

    Rosenberg NJ. Degenerative spondylolisthesis. Predisposing factors. J Bone Joint Surg Am. 1975;57(4):467474.

  • 33

    Fehlings MG, Tetreault L, Nater A, Choma T, Harrop J, Mroz T, et al. The aging of the global population: the changing epidemiology of disease and spinal disorders. Neurosurgery. 2015;77(suppl 4):S1S5.

    • Search Google Scholar
    • Export Citation
  • 34

    Foley KT, Lefkowitz MA. Advances in minimally invasive spine surgery. Clin Neurosurg. 2002;49:499517.

  • 35

    Tsahtsarlis A, Wood M. Minimally invasive transforaminal lumber interbody fusion and degenerative lumbar spine disease. Eur Spine J. 2012;21(11):23002305.

    • Search Google Scholar
    • Export Citation
  • 36

    Wang L, Wang Y, Li Z, Yu B, Li Y. Unilateral versus bilateral pedicle screw fixation of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF): a meta-analysis of randomized controlled trials. BMC Surg. 2014;14:87.

    • Search Google Scholar
    • Export Citation
  • 37

    Wu RH, Fraser JF, Härtl R. Minimal access versus open transforaminal lumbar interbody fusion: meta-analysis of fusion rates. Spine (Phila Pa 1976).2010;35(26):22732281.

    • Search Google Scholar
    • Export Citation
  • 38

    Tian NF, Wu YS, Zhang XL, Xu HZ, Chi YL, Mao FM. Minimally invasive versus open transforaminal lumbar interbody fusion: a meta-analysis based on the current evidence. Eur Spine J. 2013;22(8):17411749.

    • Search Google Scholar
    • Export Citation
  • 39

    Rosen DS, O’Toole JE, Eichholz KM, Hrubes M, Huo D, Sandhu FA, Fessler RG. Minimally invasive lumbar spinal decompression in the elderly: outcomes of 50 patients aged 75 years and older. Neurosurgery. 2007;60(3):503510.

    • Search Google Scholar
    • Export Citation
  • 40

    Hammad A, Wirries A, Ardeshiri A, Nikiforov O, Geiger F. Open versus minimally invasive TLIF: literature review and meta-analysis. J Orthop Surg Res. 2019;14(1):229.

    • Search Google Scholar
    • Export Citation
  • 41

    Phan K, Rao PJ, Kam AC, Mobbs RJ. Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis. Eur Spine J. 2015;24(5):10171030.

    • Search Google Scholar
    • Export Citation
  • 42

    Joseph JR, Smith BW, La Marca F, Park P. Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature. Neurosurg Focus. 2015;39(4):E4.

    • Search Google Scholar
    • Export Citation
  • 43

    Kobayashi K, Imagama S, Ando K, Ishiguro N, Yamashita M, Eguchi Y, et al. Complications associated with spine surgery in patients aged 80 years or older: Japan Association of Spine Surgeons with Ambition (JASA) Multicenter Study. Global Spine J. 2017;7(7):636641.

    • Search Google Scholar
    • Export Citation
  • 44

    Lee KH, Yue WM, Yeo W, Soeharno H, Tan SB. Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J. 2012;21(11):22652270.

    • Search Google Scholar
    • Export Citation
  • 45

    Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J. Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J. 2010;19(10):17801784.

    • Search Google Scholar
    • Export Citation
  • 46

    Kim CH, Easley K, Lee JS, Hong JY, Virk M, Hsieh PC, Yoon ST. Comparison of minimally invasive versus open transforaminal interbody lumbar fusion. Global Spine J. 2020;10(2)(suppl):143S150S.

    • Search Google Scholar
    • Export Citation
  • 47

    Parker SL, Adamson TE, Smith MD, McGirt MJ. Reduction in symptomatic adjacent segment disease after MIS versus open transforaminal lumbar interbody fusion. Spine J. 2014;14(11):S64S65.

    • Search Google Scholar
    • Export Citation
  • 48

    Yao YC, Chou PH, Lin HH, Wang ST, Liu CL, Chang MC. Risk factors of cage subsidence in patients received minimally invasive transforaminal lumbar interbody fusion. Spine (Phila Pa 1976).2020;45(19):E1279E1285.

    • Search Google Scholar
    • Export Citation
  • 49

    Kim JS, Jung B, Lee SH. Instrumented minimally invasive spinal-transforaminal lumbar interbody fusion (MIS-TLIF): minimum 5-year follow-up with clinical and radiologic outcomes. Clin Spine Surg. 2018;31(6):E302E309.

    • Search Google Scholar
    • Export Citation
  • 50

    Kim MC, Chung HT, Cho JL, Kim DJ, Chung NS. Subsidence of polyetheretherketone cage after minimally invasive transforaminal lumbar interbody fusion. J Spinal Disord Tech. 2013;26(2):8792.

    • Search Google Scholar
    • Export Citation
  • 51

    Lee DY, Park YJ, Song SY, Jeong ST, Kim DH. Risk factors for posterior cage migration after lumbar interbody fusion surgery. Asian Spine J. 2018;12(1):5968.

    • Search Google Scholar
    • Export Citation
  • 52

    Park MK, Kim KT, Bang WS, Cho DC, Sung JK, Lee YS, et al. Risk factors for cage migration and cage retropulsion following transforaminal lumbar interbody fusion. Spine J. 2019;19(3):437447.

    • Search Google Scholar
    • Export Citation
  • 53

    Oh KW, Lee JH, Lee JH, Lee DY, Shim HJ. The correlation between cage subsidence, bone mineral density, and clinical results in posterior lumbar interbody fusion. Clin Spine Surg. 2017;30(6):E683E689.

    • Search Google Scholar
    • Export Citation
  • 54

    Sharif S, Afsar A. Learning curve and minimally invasive spine surgery. World Neurosurg. 2018;119:472478.

  • 55

    Nandyala SV, Fineberg SJ, Pelton M, Singh K. Minimally invasive transforaminal lumbar interbody fusion: one surgeon’s learning curve. Spine J. 2014;14(8):14601465.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 355 355 355
Full Text Views 43 43 43
PDF Downloads 51 51 51
EPUB Downloads 0 0 0