Minimal invasive lumbar spine revision surgery at distance from the dura and postsurgical scar tissue: Extraforaminal Lumbar Interbody Fusion (ELIF)

Outpatient Spine Procedures in Poland: Clinical Outcomes, Safety, Complications, and Technical Insights into an Ambulatory Spine Surgery Center

PURPOSE

This study evaluated the safety and efficacy of spine procedures performed in an ambulatory spine surgery unit in Poland.

PATIENTS AND METHODS

We conducted a retrospective analysis of 318 patients who underwent ambulatory spine surgery between 2018 and 2021, with procedures including microdiscectomy (MLD), anterior cervical discectomy and fusion (ACDF), endoscopic interbody fusion (endoLIF), posterior endoscopic cervical discectomy (PECD), interlaminar endoscopic lumbar discectomy IELD, and transforaminal endoscopic lumbar discectomy (TELD). Patient data were analyzed for pre-operative and post-operative visual analog scale (VAS) scores.

RESULTS

The findings indicated that outpatient techniques were safe and effective, with a 2.83% complication rate. All procedures significantly improved VAS scores under short-term observation, and core outcome measurement index (COMI) scores under long-term observation.

CONCLUSIONS

Ambulatory spine surgery represents a relatively new approach in Poland, with only a select few centers currently offering this type of service. Outpatient spine surgery is a safe, effective, and cost-effective option for patients requiring basic spine surgeries.

Ten-Year Outcomes of Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion in Patients With Single-Level Lumbar Spondylolisthesis

STUDY DESIGN

A retrospective observational study.

OBJECTIVE

This study investigated the clinical and radiological results of minimally invasive (MI) versus open transforaminal lumbar interbody fusion (TLIF) in patients with single-level lumbar spondylolisthesis over a 10-year period.

SUMMARY OF BACKGROUND DATA

Few studies have compared 10-year follow-up outcomes between MI-TLIF and open TLIF.

METHODS

We retrospectively collected the outcome data of patients with single-level lumbar spondylolisthesis who underwent TLIF procedures using an MI (n = 108) or open (n = 53) approach. Fifty-two (48%) and 31 (58%) patients in the MI-TLIF and open TLIF groups, respectively, completed the 10-year follow-up. A primary clinical outcome included the Oswestry Disability Index (ODI) as well as visual analog scale (VAS) scores for back and leg pain at baseline and at 2, 5, and 10 years postoperatively. The radiographic fusion rate and incidence of secondary surgery due to adjacent segment disease were assessed at 2, 5, and 10 years postoperatively.

RESULTS

Intraoperative blood loss and length of hospitalization were significantly lower in the MI-TLIF group than in the open TLIF group. At 2 years postoperatively, the ODI and VAS scores for back and leg pain were significantly lower in the MI-TLIF group than in the open TLIF group. No significant differences were found in VAS scores for back and leg pain or ODI scores between the two groups at 10 years postoperatively. Radiographic fusion rates and prevalence of secondary surgery for adjacent segment disease were not significantly different between the groups at 10 years postoperatively.

CONCLUSION

Efficacy of MI-TLIF for patients with single-level lumbar spondylolisthesis is comparable to that of open TLIF over 10-years. However, MI-TLIF may have superior perioperative recovery and 2-year postoperative functional outcomes than open TLIF.Level of Evidence: 3.

Minimal invasive management of early revision after minimal invasive posterior lumbar fusion

BACKGROUND

Minimally invasive spine (MIS) fusion is an increasingly common procedure, with advantages over open approach in the form of minimal dissection and superior early clinical outcome. The frequency of complications is known, but the most appropriate surgical revision for this technique remains unclear.

HYPOTHESIS

The main hypothesis was that early revision surgery, for acute complications after MIS, was possible through mini-invasive approach.

METHODS

A retrospective study of patients undergoing MIS has been performed, with or without transforaminal interbody fusion (TLIF) using specific navigation and ancillary. All surgical revisions were done by minimally invasive approach. Preoperative and surgical data, as well as postoperative complications have been analyzed. The primary endpoint was clinical outcome obtained after surgical revision.

RESULTS

Data of 187 patients undergoing MIS procedure at 1-4 levels was analyzed. The rate of early revision (within one month) was 5.3%: 0.5% for infection, 1.6% for compressive hematoma, and 2.1% for misplaced screw. The use of intraoperative navigation decreased the frequency of screw misplacement from 4.5% to 1.4%. The rate of surgical revision was 7.8% for surgeons in their learning curve and 3.6% for experienced surgeons.

DISCUSSION

On these large series, MIS early revision rates were lower than previously reported for conventional fusions. Surgeon's experience in MIS procedures seems to be crucial to decrease revision and complications rates. Hemorrhagic complications led to multidisciplinary discussions and the establishment of a management protocol. Surgical revisions can be performed by minimally invasive techniques, regardless of the indication.

LEVEL OF EVIDENCE

IV, retrospective study.

[Minimally invasive transforaminal lumbar interbody fusion]

OBJECTIVE

Instrumented fusion of lumbar motion segments using a minimally invasive technique.

INDICATIONS

Degenerative disc disease, segmental degeneration, degenerative spondylolisthesis, isthmic spondylolisthesis, pseudarthrosis, other spinal lumbar instabilities, disc prolapse, revision for failed back surgery syndrome, unilateral neuroforaminal stenosis, facet joint arthrosis.

CONTRAINDICATIONS

High-grade spondylolisthesis (Meyerding grades III/IV, spondyloptosis), bilateral nerve root compression, vertebral fractures, tumors, high-grade spinal instabilities, primary spinal deformities, multilevel pathologies.

SURGICAL TECHNIQUE

Ipsilateral minimally invasive approach using a self-retaining tubular retractor system, partial or complete facetectomy, insertion of pedicle screws, transforaminal lumbar interbody fusion (TLIF) cage insertion preserving nerve roots, fusion, contralateral insertion of pedicle screws using a minimally invasive or percutaneous technique.

POSTOPERATIVE MANAGEMENT

Mobilization with physiotherapy, followed by standing plain x‑ray examinations, clinical and radiological follow-up at 6-12 weeks and 1 year postoperatively.

RESULTS

Fusion rates >90%, comparable to open TLIF. Complication rates lower than open TLIF. Shorter radiation exposure during surgery, lower blood loss. Less surgical trauma leads to shorter hospitalization time and earlier return-to-work. Oswestry Disability index (ODI) scores and visual analog scale (VAS) scores significantly decreased.

Minimally invasive unilateral lumbar interbody fusion (UNILIF) in over-80-year-olds. Continuous series of 42 patients at 1.4 years' follow-up

INTRODUCTION

In lumbar stenosis, surgery aims to improve quality of life in increasingly elderly patients. Minimally invasive techniques better suit the requirements of elderly patients with increasing functional demand.

HYPOTHESIS

The UNILIF unilateral lumbar interbody fusion technique improves functional scores at 1 year in over-80 year-olds, with low morbidity.

METHOD

Patients undergoing minimally invasive decompression with transforaminal lumbar interbody fusion (TLIF) associated to unilateral pedicle screwing for degenerative lumbar stenosis were analyzed at a minimum 1 year's follow-up. SF12, Oswestry Disability Index (ODI) and Quebec scores and sagittal spinopelvic radiographic parameters were assessed at follow-up. Surgical and general complications were also collated.

RESULTS

In all, 42 patients (64.3% female; mean age, 83.7±2.9 years) were treated by UNILIF at levels L2-L3 (3.8%), L3-L4 (15.4%), L4-L5 (71.2%) and L5-S1 (9.6%). Mean follow-up was 520±226 days (range, 340-1166 days). Mean preoperative SF12 score was 77.5±10.9, with significant improvement at last follow-up: 81.9±138 (p<0.05). Mean preoperative ODI was 44.4%±14.0, with significant improvement at last follow-up: 32.4%±13.3 (p<0.001). Mean preoperative Quebec score was 42.9±19.9, with significant improvement at last follow-up: 28.5±21.9 (p<0.001). Spinopelvic sagittal balance was not affected by the UNILIF procedure. There were no cases of infection or severe general complications during follow-up, although 2 cases of non-union required revision surgery.

CONCLUSION

Lumbar stenosis surgery by UNILIF improved functional scores at 1 year, with low morbidity. It is a suitable strategy for degenerative lumbar stenosis in elderly patients.

LEVEL OF EVIDENCE

IV, non-comparative cohort study.