Stand-alone minimally invasive lateral lumbar interbody fusion: multicenter clinical outcomes

Stand-alone minimally invasive lateral transpsoas interbody fusion (MIS-LIF), without posterior instrumentation, is feasible because the technique does not necessitate the disruption of the stabilizing elements. The objectives of this study are to evaluate the efficacy and clinical outcomes of patients who underwent stand-alone lateral interbody fusion. A multicenter chart review was conducted to identify patients who underwent stand-alone MIS-LIF between 2008 and 2012. Patients were classified by spinal pathology (degenerative disc disease [DDD], spondylolisthesis [SL] and adult degenerative scoliosis [ADS]). Routine clinical follow-up was scheduled at 3, 6, and12 months. Outcome measures included hospital length of stay, fusion rates, neurologic complications, integrity of construct and clinical outcome questionnaires (Visual Analog Scale [VAS] and Oswestry Disability Index [ODI]). A total of 59 patients met the inclusion criteria. The average age was 60 years (range 31-86 years). Spinal pathologies treated were DDD in 37 (63%), SL in four (7%) and ADS in 18 (30%) patients. Fusion rate was 93% of patients (95% of levels) at 12 months. Two patients required re-operation. Mean hospital stay and follow-up were 3.3days (range 1-10) and 14.6 months, respectively. The mean preoperative VAS and ODI were 69.1 and 51.8, respectively. VAS improved to 37.8 (p<0.0005). ODI improved to 31.8 (p<0.0005). Seventy percent of patients had grade 0 subsidence while 30% had grade I and grade II subsidence. Stand-alone MIS-LIF is viable option in a carefully selected patient population for both single and multilevel disease and shows significant improvement in health related quality of life.