The effect of surgical level on self-reported clinical outcomes after minimally invasive transforaminal lumbar interbody fusion: L4-L5 versus L5-S1

Cort D. Lawton, Zachary A. Smith, Alexander T. Nixon, Nader S. Dahdaleh, Albert P. Wong, Ryan Khanna, Abdulwahed Barnawi, Richard G. Fessler*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations

Abstract

Objective The anatomic and biomechanical aspects of the L5-S1 level present unique operative challenges compared with the L4-L5 level. However, it has not been determined if self-reported outcomes and complications are different between patients treated with a minimally invasive transforaminal lumbar interbody fusion at these specific levels. Methods There were 36 consecutive patients identified who were treated with a minimally invasive transforaminal lumbar interbody fusion procedure. Surgical indications included spondylolisthesis (grade 1 or 2) and degenerative disk disease with associated clinical symptoms. Patients completed a visual analog scale (VAS) for their back and leg and Oswestry Disability Index preoperatively and postoperatively. Outcomes were compared between patients with L4-L5 involvement and patients with L5-S1 involvement. In all patients, fusion was evaluated by dynamic view flexion and extension views at 1 year. In all patients with indeterminate results or incomplete imaging, computed tomography was performed to evaluate for bridging bone and stable hardware positioning. Results The surgical indications between the 2 groups were similar (χ2 = 0.089, df = 2, P = 0.956). There was no significant difference in mean operating time, intraoperative blood loss, and hospital stay (P = 0.937, 0.627, and 0.587). There was no significant difference in the long-term postoperative questionnaire results (P = 0.819 for VAS [back], 0.626 for VAS [leg], and 0.962 for Oswestry Disability Index) or the mean preoperative to postoperative change in Cobb angle (P = 0.626) between the 2 groups. Two complications, one in each group, were a rash from an antibiotic and postoperative nausea. Conclusions Despite differences in biomechanics and unique anatomic challenges at the L5-S1 interspace, there is no difference in self-reported outcomes for patients treated with minimally invasive transforaminal lumbar interbody fusion at the L4-L5 level compared with the L5-S1 level.

Original languageEnglish (US)
Pages (from-to)177-182
Number of pages6
JournalWorld neurosurgery
Volume81
Issue number1
DOIs
StatePublished - Jan 2014

Keywords

  • Different levels
  • Minimally invasive surgery
  • Minimally invasive transforaminal lumbar interbody fusion
  • Outcomes
  • Spine surgery
  • Transforaminal lumbar interbody fusion

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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