STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare outcomes and complications of stand-alone minimally invasive lateral interbody fusion (LIF) vs revision posterior surgery for the treatment of lumbar adjacent segment disease. METHODS: Adults who underwent LIF or transforaminal lumbar interbody fusion (TLIF) for adjacent segment disease were compared. Exclusion criteria: >grade 1 spondylolisthesis, posterior approach after LIF, and L5/S1 surgery. Patient demographics, estimated blood loss, hospital length of stay, complications, reoperations, health-related quality of life measures, and radiographs were examined. Data were analyzed with the χ2, Wilcoxon signed rank, and Mann-Whitney U tests. RESULTS: A total of 17 LIF and 16 TLIF patients were included. Demographics were similar. Follow up was similar (LIF: 22.9 ± 11.8 months vs TLIF: 22.0 ± 4.6 months; P = .86). The LIF patients had significantly less blood loss (LIF: 36 ± 16 mL vs TLIF: 700 ± 767 mL; P < .001) and shorter length of stay (LIF: 2.6 ± 2.9 days vs TLIF: 3.3 ± 0.9 days; P = .001). There were no intraoperative complications. Revision rate was 4 of 17 in LIF and 3 of 16 in TLIF (P = .73). Baseline health-related quality of life and radiographic measurements were similar. In both groups, back and leg pain scores significantly improved, and in LIF, the Owestry Disability Index, and EuroQol-5D significantly improved. The LIF had a significant increase in intervertebral height (LIF: 4.8 ± 2.9 mm, P < .001, TLIF: 1.3 ± 3.4 mm, P = .37), which was significantly greater for LIF than TLIF (P = .002). Similarly, LIF had a significant increase in segmental lordosis (LIF: 5.6° ± 4.9°, P < .001, TLIF: 3.6° ± 8.6°, P = .16), which was not significantly different between groups. CONCLUSIONS: Patients with adjacent segment disease may receive significant benefit from stand-alone LIF or TLIF. The LIF offers advantages of less blood loss and a shorter hospital stay. LEVEL OF EVIDENCE: 3.
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare outcomes and complications of stand-alone minimally invasive lateral interbody fusion (LIF) vs revision posterior surgery for the treatment of lumbar adjacent segment disease. METHODS: Adults who underwent LIF or transforaminal lumbar interbody fusion (TLIF) for adjacent segment disease were compared. Exclusion criteria: >grade 1 spondylolisthesis, posterior approach after LIF, and L5/S1 surgery. Patient demographics, estimated blood loss, hospital length of stay, complications, reoperations, health-related quality of life measures, and radiographs were examined. Data were analyzed with the χ2, Wilcoxon signed rank, and Mann-Whitney U tests. RESULTS: A total of 17 LIF and 16 TLIF patients were included. Demographics were similar. Follow up was similar (LIF: 22.9 ± 11.8 months vs TLIF: 22.0 ± 4.6 months; P = .86). The LIF patients had significantly less blood loss (LIF: 36 ± 16 mL vs TLIF: 700 ± 767 mL; P < .001) and shorter length of stay (LIF: 2.6 ± 2.9 days vs TLIF: 3.3 ± 0.9 days; P = .001). There were no intraoperative complications. Revision rate was 4 of 17 in LIF and 3 of 16 in TLIF (P = .73). Baseline health-related quality of life and radiographic measurements were similar. In both groups, back and leg pain scores significantly improved, and in LIF, the Owestry Disability Index, and EuroQol-5D significantly improved. The LIF had a significant increase in intervertebral height (LIF: 4.8 ± 2.9 mm, P < .001, TLIF: 1.3 ± 3.4 mm, P = .37), which was significantly greater for LIF than TLIF (P = .002). Similarly, LIF had a significant increase in segmental lordosis (LIF: 5.6° ± 4.9°, P < .001, TLIF: 3.6° ± 8.6°, P = .16), which was not significantly different between groups. CONCLUSIONS: Patients with adjacent segment disease may receive significant benefit from stand-alone LIF or TLIF. The LIF offers advantages of less blood loss and a shorter hospital stay. LEVEL OF EVIDENCE: 3.
Authors: Yossi Smorgick; Kevin C Baker; Casey C Bachison; Harry N Herkowitz; David M Montgomery; Jeffrey S Fischgrund Journal: Spine J Date: 2013-03-21 Impact factor: 4.166