Comparison study of Lumbar Interbody Fusion with Cortical Bone Trajectory screws versus conventional open Posterior Lumbar Interbody Fusion

Presented at SMISS Annual Forum 2014
By Tsuyoshi Okudaira MD
With Hiroaki Konishi MD, PhD, Hideo Baba MD, PhD, Ken Hiura MD, PhD, Kazuta Yamashita MD, Shuta Yamada MD,

Disclosures: Tsuyoshi Okudaira MD None Hiroaki Konishi MD, PhD None, Hideo Baba MD, PhD None, Ken Hiura MD, PhD None, Kazuta Yamashita MD None, Shuta Yamada MD None,

Introduction:
Conventional open Posterior Lumbar Interbody Fusion is an established technique for various lumbar spine pathology. Lumbar Interbody Fusion with Cortical Bone Trajectory screws (Mid-Line Lumbar Fusion ; MIDLF) can be an MIS alternative.

Aims/Objectives:
To compare perioperative and short term results of Lumbar Interbody Fusion with Cortical Bone Trajectory screws (Mid-Line Lumbar Fusion ; MIDLF) against conventional open Posterior Lumbar Interbody Fusion (PLIF).

Methods:
In 2013, sixteen patients who underwent MIDLF were analyzed retrospectively. 19 patients treated with conventional open PLIF were evaluated as a comparative group. The items reviewed were operation time, blood loss, the number of NSAIDs usage, the days needed for patients to return to normal body temperature, perioperative complications and hospital stay duration. The functional results were reviewed with JOA score (Japanese Orthopedic Association) and Visual analogue scale for back pain and leg pain.

Results:
The operation time (MIDLF: 148 min, PLIF: 184 min, P= 0.0038 ) was significantly shorter and blood loss (MIDLF : 132g , PLIF 184g , P = 0.0010 )was also significantly smaller in MIDLF cases. The days needed for the patients to return to the normal temperature(MIDLF : 4.6 days , PLIF 7.8 days, P = 0.028) were also shorter in MIDLF cases. Pain relief and functional outcomes are almost compatible in both groups. One case of deep wound infection and concomitant permanent neural damage occurred in PLIF group.

Discussion:
With the aid of illumination retractor and cortical bone trajectory screws, we can perform the interbody fusion procedure with less extensive exposure. The results showed the less invasiveness of MIDLF procedure. And functional outcomes at last follow-up are almost compatible in both groups.
Conclusions: MIDLF is compatible with conventional PLIF in terms of short term clinical results with additional benefits of less initial postoperative pain, less blood loss, shorter operation time and earlier rehabilitation.