A prospective, randomised study presented at the 32nd EUROSPINE annual meeting held 11–13 October in Dublin, Ireland by Gabriel Tender (Louisiana State University, New Orleans, USA) has confirmed results that show minimally invasive techniques in transforaminal lumbar interbody fusion (TLIF) result in similar outcomes as standard TLIF procedures.
Additionally, the results demonstrated that patients who underwent the minimally invasive TLIF procedure had shorter hospital stays—an average 1.9 days compared to 4.1 days for those who underwent the standard surgery (p<0.0001), a highly significant result.
Tender said, “retrospective literature suggests that minimally invasive techniques are superior, but few prospective randomised studies are available,” making the study with co-author Anthony DiGiorgio (also of Louisiana State University, New Orleans, USA) an important piece of evidence that may encourage the use of minimally invasive technqiues in TLIF surgery.
The study was conducted at Bagdasar-Arseni Clinical Emergency Hospital (Bucharest, Romania) between 2011 and 2015 on 80 patients, all of whom had at least six months of symptoms and either grade 1 or grade 2 spondylolisthesis, confirmed by imaging. The patients were randomly assigned to each group, with 40 patients in each cohort. All 80 patients were followed up one year post-surgery.
The paper also looked at the operative time, estimated blood loss during surgery, improvement in the Oswestry Disability Index (ODI), and fusion rates. In both cohorts, patients showed similar levels of fusion and similar improvement in ODI after on year. However, in the minimally invasive patients, the average blood loss was 351mL, compared to 417mL lost during surgery for the patients who had standard TLIF surgery (p=0.153), a result that is promising but did not reach statistical significance. The operative time for the minimally invasive TLIF cohort was on average 322 minutes, compared to 296 minutes in the standard surgery group (p=0.219), which also did not show statistical significance. There were no postoperative complications in all 80 patients.
The authors suggest that a multi-centre trial will be a necessary next step in confirming their results.