Comparison of local and regional radiographic outcomes in minimally invasive and open TLIF: a propensity score–matched cohort

View More View Less
  • 1 Departments of Neurological Surgery and
  • | 2 Orthopedic Surgery, Washington University, St. Louis, Missouri; and
  • | 3 Department of Neurological Surgery, Johns Hopkins University, Baltimore, Maryland
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 Sign in

OBJECTIVE

Local and regional radiographic outcomes following minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) versus open TLIF remain unclear. The purpose of this study was to provide a comprehensive assessment of local and regional radiographic parameters following MI-TLIF and open TLIF. The authors hypothesized that open TLIF provides greater segmental and global lordosis correction than MI-TLIF.

METHODS

A single-center retrospective cohort study of consecutive patients undergoing MI- or open TLIF for grade I degenerative spondylolisthesis was performed. One-to-one nearest-neighbor propensity score matching (PSM) was used to match patients who underwent open TLIF to those who underwent MI-TLIF. Sagittal segmental radiographic measures included segmental lordosis (SL), anterior disc height (ADH), posterior disc height (PDH), foraminal height (FH), percent spondylolisthesis, and cage position. Lumbopelvic radiographic parameters included overall lumbar lordosis (LL), pelvic incidence (PI)–lumbar lordosis (PI-LL) mismatch, sacral slope (SS), and pelvic tilt (PT). Change in segmental or overall lordosis after surgery was considered "lordosing" if the change was > 0° and "kyphosing" if it was ≤ 0°. Student t-tests or Wilcoxon rank-sum tests were used to compare outcomes between MI-TLIF and open-TLIF groups.

RESULTS

A total of 267 patients were included in the study, 114 (43%) who underwent MI-TLIF and 153 (57%) who underwent open TLIF, with an average follow-up of 56.6 weeks (SD 23.5 weeks). After PSM, there were 75 patients in each group. At the latest follow-up both MI- and open-TLIF patients experienced significant improvements in assessment scores obtained with the Oswestry Disability Index (ODI) and the numeric rating scale for low-back pain (NRS-BP), without significant differences between groups (p > 0.05). Both MI- and open-TLIF patients experienced significant improvements in SL, ADH, and percent corrected spondylolisthesis compared to baseline (p < 0.001). However, the MI-TLIF group experienced significantly larger magnitudes of correction with respect to these metrics (ΔSL 4.14° ± 4.35° vs 1.15° ± 3.88°, p < 0.001; ΔADH 4.25 ± 3.68 vs 1.41 ± 3.77 mm, p < 0.001; percent corrected spondylolisthesis: −10.82% ± 6.47% vs −5.87% ± 8.32%, p < 0.001). In the MI-TLIF group, LL improved in 44% (0.3° ± 8.5°) of the cases, compared to 48% (0.9° ± 6.4°) of the cases in the open-TLIF group (p > 0.05). Stratification by operative technique (unilateral vs bilateral facetectomy) and by interbody device (static vs expandable) did not yield statistically significant differences (p > 0.05).

CONCLUSIONS

Both MI- and open-TLIF patients experienced significant improvements in patient-reported outcome (PRO) measures and local radiographic parameters, with neutral effects on regional alignment. Surprisingly, in our cohort, change in SL was significantly greater in MI-TLIF patients, perhaps reflecting the effect of operative techniques, technological innovations, and the preservation of the posterior tension band. Taking these results together, no significant overall differences in LL between groups were demonstrated, which suggests that MI-TLIF is comparable to open approaches in providing radiographic correction after surgery. These findings suggest that alignment targets can be achieved by either MI- or open-TLIF approaches, highlighting the importance of surgeon attention to these variables.

ABBREVIATIONS

ADH = anterior disc height; ASA = American Society of Anesthesiologists; FH = foraminal height; ICC = intraclass correlation coefficient; LL = lumbar lordosis; MI = minimally invasive; NRS-BP = numeric rating scale for low-back pain; ODI = Oswestry Disability Index; PDH = posterior disc height; PI = pelvic incidence; PLIF = posterior lumbar interbody fusion; PRO = patient-reported outcome; PSM = propensity score matching; PT = pelvic tilt; SL = segmental lordosis; SMD = standardized mean difference; SS = sacral slope; TLIF = transforaminal lumbar interbody fusion.

Supplementary Materials

    • Supplemental Fig 1 and Supplemental Table 1 (PDF 1,477 KB)

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

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

USD  $612.00
  • 1

    Rothrock RJ, McNeill IT, Yaeger K, Oermann EK, Cho SK, Caridi JM. Lumbar lordosis correction with interbody fusion: systematic literature review and analysis. World Neurosurg. 2018;118:2131.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion: I. Indications, operative technique, after care. J Neurosurg. 1953;10(2):154168.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Harms J, Rolinger H. A one-stager procedure in operative treatment of spondylolistheses: dorsal traction-reposition and anterior fusion. Article in German. Z Orthop Ihre Grenzgeb. 1982;120(3):343347.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

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

  • 5

    Goldstein CL, Macwan K, Sundararajan K, Rampersaud YR. Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review. J Neurosurg Spine. 2016;24(3):416427.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    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.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Qin R, Liu B, Zhou P, et al. Minimally invasive versus traditional open transforaminal lumbar interbody fusion for the treatment of single-level spondylolisthesis grades 1 and 2: a systematic review and meta-analysis. World Neurosurg. 2019;122:180189.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Le H, Anderson R, Phan E, et al. Clinical and radiographic comparison between open versus minimally invasive transforaminal lumbar interbody fusion with bilateral facetectomies. Global Spine J. 2021;11(6):903910.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Liu J, Duan P, Mummaneni PV, et al. Does transforaminal lumbar interbody fusion induce lordosis or kyphosis? Radiographic evaluation with a minimum 2-year follow-up. J Neurosurg Spine. 2021;35(4):419426.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Miller LE, Bhattacharyya S, Pracyk J. Minimally invasive versus open transforaminal lumbar interbody fusion for single-level degenerative disease: a systematic review and meta-analysis of randomized controlled trials. World Neurosurg. 2020;133:358365.e4.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Jagannathan J, Sansur CA, Oskouian RJ Jr, Fu KM, Shaffrey CI. Radiographic restoration of lumbar alignment after transforaminal lumbar interbody fusion. Neurosurgery. 2009;64(5):955964.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Carlson BB, Saville P, Dowdell J, et al. Restoration of lumbar lordosis after minimally invasive transforaminal lumbar interbody fusion: a systematic review. Spine J. 2019;19(5):951958.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344349.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Khalifeh JM, Dibble CF, Stecher P, Dorward I, Hawasli AH, Ray WZ. Transfacet minimally invasive transforaminal lumbar interbody fusion with an expandable interbody device—part II: consecutive case series. Oper Neurosurg (Hagerstown). 2020;19(5):518529.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Djurasovic M, Rouben DP, Glassman SD, Casnellie MT, Carreon LY. Clinical outcomes of minimally invasive versus open TLIF: a propensity-matched cohort study. Am J Orthop. 2016;45(3):E77E82.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Wu AM, Hu ZC, Li XB, et al. Comparison of minimally invasive and open transforaminal lumbar interbody fusion in the treatment of single segmental lumbar spondylolisthesis: minimum two-year follow up. Ann Transl Med. 2018;6(6):105.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Seng C, Siddiqui MA, Wong KP, et al. Five-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion: a matched-pair comparison study. Spine (Phila Pa 1976). 2013;38(23):20492055.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Wong AP, Smith ZA, Stadler JA III, et al. Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF): surgical technique, long-term 4-year prospective outcomes, and complications compared with an open TLIF cohort. Neurosurg Clin N Am. 2014;25(2):279304.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Lee WC, Park JY, Kim KH, et al. Minimally invasive transforaminal lumbar interbody fusion in multilevel: comparison with conventional transforaminal interbody fusion. World Neurosurg. 2016;85:236243.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Sulaiman WA, Singh M. Minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis grades 1-2: patient-reported clinical outcomes and cost-utility analysis. Ochsner J. 2014;14(1):3237.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Qin R, Wu T, Liu H, Zhou B, Zhou P, Zhang X. Minimally invasive versus traditional open transforaminal lumbar interbody fusion for the treatment of low-grade degenerative spondylolisthesis: a retrospective study. Sci Rep. 2020;10(1):21851.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Hey HW, Hee HT. Open and minimally invasive transforaminal lumbar interbody fusion: comparison of intermediate results and complications. Asian Spine J. 2015;9(2):185193.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Lv Y, Chen J, Chen J, et al. Three-year postoperative outcomes between MIS and conventional TLIF in1-segment lumbar disc herniation. Minim Invasive Ther Allied Technol. 2017;26(3):168176.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Brodano GB, Martikos K, Lolli F, et al. Transforaminal lumbar interbody fusion in degenerative disk disease and spondylolisthesis grade I: minimally invasive versus open surgery. J Spinal Disord Tech. 2015;28(10):E559E564.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    Staffa SJ, Zurakowski D. Five steps to successfully implement and evaluate propensity score matching in clinical research studies. Anesth Analg. 2018;127(4):10661073.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Zhao QY, Luo JC, Su Y, Zhang YJ, Tu GW, Luo Z. Propensity score matching with R: conventional methods and new features. Ann Transl Med. 2021;9(9):812.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat. 2011;10(2):150161.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Zhang Z, Kim HJ, Lonjon G, Zhu Y. Balance diagnostics after propensity score matching. Ann Transl Med. 2019;7(1):16.

  • 29

    Villavicencio AT, Burneikiene S, Roeca CM, Nelson EL, Mason A. Minimally invasive versus open transforaminal lumbar interbody fusion. Surg Neurol Int. 2010;1:12.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Kim CH, Easley K, Lee JS, et al. Comparison of minimally invasive versus open transforaminal interbody lumbar fusion. Global Spine J. 2020;10(2)(suppl):143S150S.

  • 31

    Price JP, Dawson JM, Schwender JD, Schellhas KP. Clinical and radiologic comparison of minimally invasive surgery with traditional open transforaminal lumbar interbody fusion: a review of 452 patients from a single center. Clin Spine Surg. 2018;31(2):E121E126.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    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.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Chan AK, Bisson EF, Bydon M, et al. A comparison of minimally invasive and open transforaminal lumbar interbody fusion for grade 1 degenerative lumbar spondylolisthesis: an analysis of the prospective Quality Outcomes Database. Neurosurgery. 2020;87(3):555562.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Li YB, Wang XD, Yan HW, Hao DJ, Liu ZH. The long-term clinical effect of minimal-invasive TLIF technique in 1-segment lumbar disease. Clin Spine Surg. 2017;30(6):E713E719.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Alvi MA, Kurian SJ, Wahood W, Goyal A, Elder BD, Bydon M. Assessing the difference in clinical and radiologic outcomes between expandable cage and nonexpandable cage among patients undergoing minimally invasive transforaminal interbody fusion: a systematic review and meta-analysis. World Neurosurg. 2019;127:596606.e1.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Hawasli AH, Khalifeh JM, Chatrath A, Yarbrough CK, Ray WZ. Minimally invasive transforaminal lumbar interbody fusion with expandable versus static interbody devices: radiographic assessment of sagittal segmental and pelvic parameters. Neurosurg Focus. 2017;43(2):E10.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Yee TJ, Joseph JR, Terman SW, Park P. Expandable vs static cages in transforaminal lumbar interbody fusion: radiographic comparison of segmental and lumbar sagittal angles. Neurosurgery. 2017;81(1):6974.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Landham PR, Don AS, Robertson PA. Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction. Eur Spine J. 2017;26(11):28432850.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Kwon BK, Berta S, Daffner SD, et al. Radiographic analysis of transforaminal lumbar interbody fusion for the treatment of adult isthmic spondylolisthesis. J Spinal Disord Tech. 2003;16(5):469476.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    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.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Vedantam A, Verla T, Mayer RR, Raber MR, Ropper AE. Use of an open-frame hinged surgical table to restore segmental lumbar lordosis after posterior column osteotomy. Int J Spine Surg. 2020;14(3):316320.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42

    Sebastian AS, Ahmed A, Vernon B, et al. Effect of an adjustable hinged operating table on lumbar lordosis during lumbar surgery. Spine (Phila Pa 1976). 2018;43(4):302306.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43

    Vaishnav AS, Saville P, McAnany S, et al. Retrospective review of immediate restoration of lordosis in single-level minimally invasive transforaminal lumbar interbody fusion: a comparison of static and expandable interbody cages. Oper Neurosurg (Hagerstown). 2020;18(5):518523.

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 834 834 141
Full Text Views 142 142 33
PDF Downloads 167 167 42
EPUB Downloads 0 0 0