Minimally invasive LLIF surgery to decrease the occurrence of adjacent-segment disease compared to conventional open...

Area of Science:

• Spine surgery
• Minimally invasive spine procedures
• Adjacent segment disease

Background:

• Minimally invasive lateral lumbar interbody fusion (Mis-LLIF) aims to reduce posterior element damage and adjacent segment disease (ASD) incidence.
• Conventional open transforaminal interbody fusion (TLIF) is a standard surgical approach for lumbar interbody fusion.
• Understanding the comparative efficacy of Mis-LLIF versus TLIF in preventing ASD is crucial for surgical decision-making.

Purpose of the Study:

• To compare the occurrence of adjacent segment disease (ASD) between Mis-LLIF and conventional open transforaminal interbody fusion (TLIF).
• To investigate the impact of surgical technique differences, such as vertebral distraction (∆H), on ASD incidence.

Main Methods:

• Retrospective review of 156 patients undergoing single-level lumbar interbody fusion (2003-2018) with a minimum 2-year follow-up.
• Propensity score (PS) matching of 51 paired patients from Mis-LLIF and TLIF groups based on demographic and clinical data.
• Assessment of symptomatic ASD requiring reoperation (S-ASD) and radiological ASD (R-ASD) at 2 years postoperatively.

Main Results:

• No significant difference in S-ASD incidence between Mis-LLIF and TLIF groups (adjusted OR 1.3).
• No significant difference in R-ASD incidence at cranial or caudal levels between the groups.
• Significantly greater distraction (∆H) in the Mis-LLIF group (3.6 mm vs. 1.7 mm) was an independent risk factor for S-ASD and cranial R-ASD.

Conclusions:

• Mis-LLIF did not significantly reduce the incidence of R-ASD or S-ASD compared to TLIF.
• Increased vertebral distraction (∆H) in Mis-LLIF may contribute to ASD development.
• Utilizing thinner interbody cages in both TLIF and Mis-LLIF may help mitigate ASD occurrence.