STUDY DESIGN: Retrospective cohort study. OBJECTIVE: We studied patients who underwent minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) to those to who received open TLIF to compare revision rates, functional outcomes, and satisfaction at 5 years after surgery.
SUMMARY OF BACKGROUND DATA: MI procedures have recognized advantages over open procedures. However, if the decompression is inadequate or if implants are not optimally placed (for examples), a revision may subsequently be necessary. Various studies have demonstrated that there is no difference between these approaches at more than 12 months of follow-up.
METHODS: We studied adults who received transforaminal lumbar interbody fusion at 1 or 2 levels mainly for degenerative spondylolisthesis or stenosis. Patient records were reviewed surgery time, estimated blood loss, intraoperative duration of imaging radiation, and length of stay in the hospital. Pre- and postoperative function outcomes (Oswestry Disability Index, ODI), satisfaction rating at last follow-up, sagittal alignment, and revision rates were also collected.
RESULTS: At 5 years postoperatively, we found no differences between open and MI-TLIF in ODI and satisfaction. Among MI-TLIF patients, 22% required revision surgery compared with 28% of open patients. This difference was not statistically significant (P=0.5). The median time until revision was longer for MI-TLIF patients (102 wk) compared with open TLIF patients (56 wk), but the difference was not statistically significant at 5 years (P=0.07). Surgical time, blood loss, and length of stay were better for the MI group but radiation exposure was greater compared with the open group.
CONCLUSIONS: About one fourth of open and MI-TLIF patients may expect a revision surgery within 5 years of their index procedure.
LEVEL OF EVIDENCE: Level III.