Clinical and Radiological Outcome of Mini Modified Open and Open TLIF - A Comparative Study

Presented at SMISS Annual Forum 2018
By F. Syed
With Richard Hynes , Yoshinao Koike , Hidemasa Terao , Hiroyuki Tachi MD, Yusuke Kameda , Yasushi Yabuuchi ,

Disclosures: F. Syed None Richard Hynes None, Yoshinao Koike None, Hidemasa Terao None, Hiroyuki Tachi MD None, Yusuke Kameda None, Yasushi Yabuuchi None,

Introduction:

Studies have shown that open TLIF is associated with extensive soft tissue dissection for attaining a proper later to medial trajectory for the pedicle screws, increased blood loss, damage to the paraspinal musculature resulting in increased postoperative pain and impaired spinal function. Both MO TLIF and pTLIF is associated with minimal tissue dissection, less blood loss, fewer hospitalization days, reduced postoperative pain, early mobilization and rehabilitation. We modified the MO TLIF by using a single midline incision and special retractors for direct free hand insertion of pedicle screws. The aim of this study was to analyse the clinical and radiological outcome of MO TLIF and modified mini open TLIF (modMOTLIF).

Aims/Objectives:

Studies have shown that minimally invasive transforaminal lumbar interbody fusion (MTLIF) is associated with less blood loss, shorter hospital stays and less pain. We modified the MTLIF technique by direct free hand insertion of pedicle screws using stab incisions without tubular retractors and compared the clinical and radiological outcome of modified mini open TLIF (modMOTLIF) versus open TLIF(OTLIF).

Methods:

The study included 24 patients in modMOTLIF and 27 patients in OTLIF group. Average period of follow up was 25.6 months. Clinical outcome was measured using VAS and ODI. Serial X rays were done at 1, 3, 6 and 12 and 24 months to assess union and presence of instability. We also compared the blood loss and length of hospital stay in both the groups.

Results:

All patients had a progressive improvement in VAS and ODI. There was no difference in preop and postop ODI, VAS leg between the groups. The immediate postop VAS back was significantly high in OTLIF compared to modMOTLIF group whereas there was no difference at 1 and 2 yrs. Radiological analysis showed nonunion in 2 mMOTLIF and 1 OTLIF patient. Average blood loss was 63 ml in modMOTLIF group and 254 ml in OTLIF group. Mean hospital stay was 3 days for modMOTLIF and 5 days for OTLIF patients.

Conclusions:

modMOTLIF is associated with reduced blood loss, shorter hospital stay compared with OTLIF. There is no significant difference in the clinical and radiological outcome between both the groups at the end of two years despite reduced back pain in the immediate postoperative period in modMOTLIF patients.