Revision Rates After 1 or 2 Level Transforaminal Lumbar Interbody Fusion Are Not Different Between Minimally Invasive and Open Procedures at 5 Years: A Retrospective Cohort Study of 84 Patients.

Abstract

Retrospective cohort study. 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. 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. 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. 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. About one fourth of open and MI-TLIF patients may expect a revision surgery within 5 years of their index procedure. Level III.