Comparison of the mid-and long-term clinical outcomes of Minimally invasive versus open Transforaminal Lumbar Interbody Fusion in treatment of one-level lumbar degenerative disease

Objective To investigate the mid-and long-term clinical outcomes of minimally invasive(MIS) versus open transforaminal lumbar interbody fusion(TLIF) in treatment of one-level lumbar degenerative disease.Methods 92 patients with one-level lumbar degenerative disease underwent surgical intervention were retrospectively analyzed,47 patients in MIS-TLIF group and 45 patients in open-TLIF group.MIS-TLIF was done by using expandable working tubes(Quadrant) and percutaneous pedicle screws(Sextant).Operative time,intra-operative bleeding,radiation exposure time,time to resume early activity,hospital time and general complications were recorded.Postsurgical pain and functional results were analyzed by the visual analog scale(VAS) and Oswestry Disability Index(ODI).Radiological examination was obtained to assess the height of intervertebral space,postoperative intervertebral fusion conditions and long term complications.Results The mean follow-up was 5.3 years,with a range of 4 to 7 years.The group of MIS-TLIF was superior to the group of open-TLIF in intra-operative bleeding,time to resume early activity,hospital time(P0.05).The group of MIS-TLIF need more operation time and were exposed to more X-ray compared to the open-TLIF group(P0.05).The most frequently used methods to assess the clinical function were visual analog VAS scores and ODI scores.The ODI and VAS scores post-operation improved significantly in each group(P0.05),but showed no significant difference between the 2 groups at pre-operation and last follow-up(P0.05).No statistical difference of each patient to assess the height of intervertebral space between preoperation and final follow-up for each group was noted(P0.05),but the postoperative radiologic indexes of all patients were higher than the preoperative ones(P0.05).The fusion rate was no significant difference between the two groups(P0.05).The MIS-TLIF group was associated with significantly reduced the incidence of the adjacent segment disease(P0.05).There were no complications such as secondary scoliosis,intervertebral altitude loss,cage slippage,screw loosening and internal fixation failure during the follow-up period.Conclusion MIS-TLIF was superior to open-TLIF in intra-operative bleeding,time to resume early activity,hospital time,reduced the incidence of the adjacent segment disease,but it needs more operation time and radiation exposure.MIS-TLIF and open-TLIF can both get satisfactory mid- and long-term clinical outcomes in treatment of one-level lumbar degenerative disease.