J Korean Med Sci.  2022 Apr;37(13):e105. 10.3346/jkms.2022.37.e105.

Long-Term Clinical and Radiological Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion: 10-Year Follow-up Results

• Roh YH
• Lee JC
• Hwang J
• Cho HK
• Soh J
• Choi SW
• Shin BJ

• KMID: 2527833
• DOI: http://doi.org/10.3346/jkms.2022.37.e105

Abstract

Background
Many studies have reported that minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) provides satisfactory treatment comparable to other fusion methods. However, in the case of MI-TLIF, there are concerns about the long-term outcome compared to conventional bilateral PLIF due to the small amount of disc removal and the lack of autogenous bone graft. Long-term follow-up studies are still lacking as most of the previous reports have follow-up periods of up to 5 years.
Methods
Thirty patients who underwent MI-TLIF were followed up for > 10 years (mean, 11.1 years). Interbody fusion rates were determined using a modified Bridwell grading system. Adjacent segment disease (ASD) was defined as radiological adjacent segment degeneration (R-ASDeg) as seen on plain X-rays; reoperated adjacent segment disease referred to the subsequent need for revision surgery. Clinical outcomes after surgery were assessed based on back and leg pain as well as the Oswestry disability index (ODI).
Results
The overall radiological fusion rate, at the 1-, 5-, and 10-year follow-up was 77.1%, 91.4%, and 94.3%, respectively. The incidence of R-ASDeg 1, 5, and 10 years after surgery was 6.7%, 16.7%, and 43.3% at the proximal adjacent segment and 4.8%, 14.3%, and 28.6% at the distal adjacent segment, respectively. R-ASDeg at either the proximal or distal segment was determined in 50.0% of the patients 10 years postoperatively. All clinical parameters improved significantly during follow-up, although the ODI and the visual analog scale (VAS) for leg pain at the 10-year follow-up were significantly worse in the R-ASDeg group than in the other patients (P = 0.009, P = 0.040).
Conclusion
MI-TLIF improved both clinical and radiological outcomes, and the improvements were maintained for up to 10 years after surgery. However, R-ASDeg developed in up to 50% of the patients within 10 years, and both leg pain on the VAS and the ODI were worse in patients with R-ASDeg.

Keyword

Degenerative Lumbar Disease; Long-term Follow Up; Minimally Invasive Transforaminal Interbody Fusion; Ten Years

Figure

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  Fig. 1 The overall radiological fusion rates, as defined by Bridwell grade 1 or 2, at the 1-, 5-, and 10-year follow-up examinations.*P < 0.05.

• 

  Fig. 2 Leg pain as assessed using the ODI. The difference in leg pain between patients with and without R-ASDeg was statistically significant.ODI = Oswestry disability index, R-ASDeg = radiological adjacent segment degeneration.*P < 0.05; **P < 0.01.

• 

  Fig. 3 The visual analog scale and ODI for LBP and leg RP as measured 1, 5, and 10 years postoperatively.LBP = low back pain, RP = radiating pain, ODI = Oswestry disability index.**P < 0.01; ***P < 0.001.

• 

  Fig. 4 Kaplan-Meier survival curves. (A) R-ASDeg according to follow-up period. (B) O-ASD according to follow-up period. (C) R-ASDeg according to fusion length. (D) O-ASD according to fusion length.R-ASDeg = radiological adjacent segment degeneration, O-ASD = reoperated adjacent segment disease.

• 

  Fig. 5 Chronological CT images of the spine. (A-C) CT after MI-TLIF of segment L5–S1. The coronal images were taken 1, 5, and 10 years after surgery. Over time, bony bridging around the cage resulted in the formation of a solid union. (D-F) CT sagittal images of segment L5–S1 taken 1, 5, and 10 years after MI-TLIF. Progressive bony bridging is seen along the cage together with callus formation in the anterior and posterior disc spaces, confirming solid union. However, 10 years postoperatively, a vacuum sign indicates disc degeneration of the proximal adjacent segment.CT = computed tomography, MI-TLIF = minimally invasive transforaminal lumbar interbody fusion.

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