Postoperative clinical outcomes in patients undergoing MIS-TLIF versus LLIF for adjacent segment disease

• Published in: Acta neurochirurgica Vol. 165; no. 7; pp. 1907 - 1914
• Main Authors: Nie, James W., Hartman, Timothy J., Zheng, Eileen, MacGregor, Keith R., Oyetayo, Omolabake O., Massel, Dustin H., Sayari, Arash J., Singh, Kern
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01-07-2023; Springer Nature B.V
• Subjects: Clinical outcomes; Humans; Interventional Radiology; Leg; Lumbar Vertebrae - surgery; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Minimally Invasive Surgical Procedures - methods; Neurology; Neuroradiology; Neurosurgery; Original Article; Pain - etiology; Patients; Retrospective Studies; Spinal Fusion - methods; Spine - Other; Surgical Orthopedics; Treatment Outcome; ASD; PROM; MCID; LLIF; MIS-TLIF
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-023-05629-z

Purpose
Few studies examine the clinical outcomes in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) versus lateral lumbar interbody fusion (LLIF) for adjacent segment disease (ASD). We aim to compare the postoperative clinical trajectory through patient-reported outcome measures (PROMs) and minimum clinically important difference (MCID) in patients undergoing MIS-TLIF versus LLIF for ASD.
Methods
Patients were stratified into two cohorts based on surgical technique for ASD: MIS-TLIF versus LLIF. PROMs of 12-Item Short Form Physical Component Score (SF-12 PCS), visual analog scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) were collected at preoperative and postoperative 6-week/12-week/6-month/1-year time points. MCID attainment was calculated through comparison to established thresholds. Cohorts were compared through nonparametric inferential statistics.
Results
Fifty-four patients were identified, with 22 patients undergoing MIS-TLIF after propensity score matching. Patients undergoing MIS-TLIF for ASD demonstrated significant postoperative improvement up to 1-year VAS back, up to 1-year VAS leg, and 6-month through 1-year ODI (
p
≤ 0.035, all). Patients undergoing LLIF demonstrated significant postoperative improvement in 6-month SF-12 PCS, 6-month through 1-year VAS back, 12-week through 6-month VAS leg, and 6-month to 1-year ODI (
p
≤ 0.035, all). No significant differences were calculated between surgical techniques for PROMs or MCID achievement rates.
Conclusion
Patients undergoing either MIS-TLIF or LLIF for adjacent segment disease demonstrated significant postoperative improvement in pain and disability outcomes. Additionally, patients undergoing LLIF reported significant improvement in physical function. Both MIS-TLIF and LLIF are effective for the treatment of adjacent segment disease.