A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis.

dc.contributor.author

Chan, Andrew K

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Bisson, Erica F

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Bydon, Mohamad

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Glassman, Steven D

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Foley, Kevin T

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Potts, Eric A

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Shaffrey, Christopher I

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Shaffrey, Mark E

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Coric, Domagoj

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Knightly, John J

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Park, Paul

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Wang, Michael Y

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Fu, Kai-Ming

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Slotkin, Jonathan R

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Asher, Anthony L

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Virk, Michael S

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Kerezoudis, Panagiotis

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Alvi, Mohammed Ali

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Guan, Jian

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Haid, Regis W

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Mummaneni, Praveen V

dc.date.accessioned

2023-06-20T13:50:03Z

dc.date.available

2023-06-20T13:50:03Z

dc.date.issued

2019-05

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2023-06-20T13:50:02Z

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OBJECTIVEThe optimal minimally invasive surgery (MIS) approach for grade 1 lumbar spondylolisthesis is not clearly elucidated. In this study, the authors compared the 24-month patient-reported outcomes (PROs) after MIS transforaminal lumbar interbody fusion (TLIF) and MIS decompression for degenerative lumbar spondylolisthesis.METHODSA total of 608 patients from 12 high-enrolling sites participating in the Quality Outcomes Database (QOD) lumbar spondylolisthesis module underwent single-level surgery for degenerative grade 1 lumbar spondylolisthesis, of whom 143 underwent MIS (72 MIS TLIF [50.3%] and 71 MIS decompression [49.7%]). Surgeries were classified as MIS if there was utilization of percutaneous screw fixation and placement of a Wiltse plane MIS intervertebral body graft (MIS TLIF) or if there was a tubular decompression (MIS decompression). Parameters obtained at baseline through at least 24 months of follow-up were collected. PROs included the Oswestry Disability Index (ODI), numeric rating scale (NRS) for back pain, NRS for leg pain, EuroQol-5D (EQ-5D) questionnaire, and North American Spine Society (NASS) satisfaction questionnaire. Multivariate models were constructed to adjust for patient characteristics, surgical variables, and baseline PRO values.RESULTSThe mean age of the MIS cohort was 67.1 ± 11.3 years (MIS TLIF 62.1 years vs MIS decompression 72.3 years) and consisted of 79 (55.2%) women (MIS TLIF 55.6% vs MIS decompression 54.9%). The proportion in each cohort reaching the 24-month follow-up did not differ significantly between the cohorts (MIS TLIF 83.3% and MIS decompression 84.5%, p = 0.85). MIS TLIF was associated with greater blood loss (mean 108.8 vs 33.0 ml, p < 0.001), longer operative time (mean 228.2 vs 101.8 minutes, p < 0.001), and longer length of hospitalization (mean 2.9 vs 0.7 days, p < 0.001). MIS TLIF was associated with a significantly lower reoperation rate (14.1% vs 1.4%, p = 0.004). Both cohorts demonstrated significant improvements in ODI, NRS back pain, NRS leg pain, and EQ-5D at 24 months (p < 0.001, all comparisons relative to baseline). In multivariate analyses, MIS TLIF-as opposed to MIS decompression alone-was associated with superior ODI change (β = -7.59, 95% CI -14.96 to -0.23; p = 0.04), NRS back pain change (β = -1.54, 95% CI -2.78 to -0.30; p = 0.02), and NASS satisfaction (OR 0.32, 95% CI 0.12-0.82; p = 0.02).CONCLUSIONSFor symptomatic, single-level degenerative spondylolisthesis, MIS TLIF was associated with a lower reoperation rate and superior outcomes for disability, back pain, and patient satisfaction compared with posterior MIS decompression alone. This finding may aid surgical decision-making when considering MIS for degenerative lumbar spondylolisthesis.

dc.identifier

2019.2.FOCUS18722

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1092-0684

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1092-0684

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https://hdl.handle.net/10161/28214

dc.language

eng

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Journal of Neurosurgery Publishing Group (JNSPG)

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Neurosurgical focus

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10.3171/2019.2.focus18722

dc.subject

Lumbar Vertebrae

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Humans

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Spondylolisthesis

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Treatment Outcome

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Decompression, Surgical

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Spinal Fusion

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Cohort Studies

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Time Factors

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Databases, Factual

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Aged

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Aged, 80 and over

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Middle Aged

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Patient Satisfaction

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Female

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Male

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Minimally Invasive Surgical Procedures

dc.title

A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

E13

pubs.issue

5

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

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Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

46

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