Comparison of minimally invasive spine surgery using intraoperative computed tomography integrated navigation, fluoroscopy and conventional open surgery for lumbar spondylolisthesis: a prospective registry-based cohort study

Abstract Background context Till date, the surgical approaches for the treatment of lumbar spondylolisthesis by transforaminal lumbar interbody fusion (TLIF) using minimally invasive spine surgery assisted with intraoperative CT image-integrated navigation (MISS-iCT), fluoroscopy (MISS-FS) and conventional open surgery (OS) are debatable. Purpose This study compared TLIF using MISS-iCT, MISS-FS and OS for treatment of one-level lumbar spondylolisthesis. Study design This is a prospective registry-based cohort study which compared surgical approaches for patients who underwent surgical treatment for one-level lumbar spondylolisthesis. Patient's sample One hundred and twenty four patients from January, 2010 to March, 2012 in a medical center were recruited. Outcome measures Clinical assessments including Short Form-12, visual analog scale (VAS), Oswestry disability index, core-outcome measurement index, and patient satisfaction. Blood loss, hospital stay, operation time, postoperative pedicle screw accuracy and superior-level facet violation. Methods All surgeries were performed by two senior surgeons together. Ninety-nine patients (40M, 59F) who had at least 2 years follow-up were divided into 3 groups according to the operation methods: MISS-iCT (N=24), MISS-FS (N=23) and OS (N=52) groups. Charts and surgical records along with postoperative CT images were assessed. Results MISS-iCT and MISS-FS demonstrated a significantly lowered blood loss and hospital stay compared to OS group (p 2mm) was found. However, a lower superior-level facet violation rate was noticed in MISS-iCT and OS groups (p=.049). Conclusions MISS-iCT TLIF demonstrated reduced operation time, blood loss, superior-level facet violation, hospital stay and improved functional outcomes compared to MISS-FS and OS approaches.