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Updated: Jul 11, 2025
Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion
Published on: June 16, 2023
Long-Term Results of Minimally Invasive Transforaminal Lumbar Interbody Fusion in Elderly Patients: A 5-Year
Graham S Goh1, Adriel You Wei Tay1, Gerald J Zeng1
1Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
Study Design:
Retrospective review of prospective data.
Objectives:
Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may be beneficial for elderly patients due to decreased surgical morbidity and faster postoperative recovery. This study compared the clinical and radiological outcomes of MIS-TLIF in elderly patients and younger controls at minimum 5-year follow-up.
Methods:
There were 120 patients who underwent single-level MIS-TLIF for degenerative spondylolisthesis. Elderly patients (≥70 years; n = 30) and controls (<70 years; n = 90) were matched 1:3 for demographics, comorbidities and preoperative patient-reported outcomes (PROs). The Oswestry Disability Index (ODI), 36-Item Short-Form Physical (SF-36 PCS) and Mental Component Summary (SF-36 MCS), Visual Analogue Scale (VAS) back pain, and VAS leg pain were compared at 6 months, 2 years and 5 years. Radiographic fusion, adjacent segment degeneration (ASD) and revision rates were assessed at mean 7.2 ± 2.0 years.
Results:
Elderly patients had longer length of stay (4.7 ± 5.8 vs 3.3 ± 1.4 days, P = .035) and more readmissions (10% vs 1%, P = .019), but there was no difference in operative time, transfusions, complications or discharge disposition. All PROs were comparable at 5 years and satisfaction rates were similar (93% elderly vs 91% controls, P = .703). The rates of radiographic fusion in the control group and elderly group were similar (94% vs 97%, P = .605), as were the rates of ASD (40% vs 33%, P = .503). There were 3 revisions (3.3%) in the control group (2 for ASD, 1 for screw loosening) but none in the elderly group (P = .311).
Conclusions:
Elderly patients undergoing MIS-TLIF achieved similar improvements in pain, disability and quality of life that were sustained at 5 years.Level of Evidence: Level III, retrospective cohort study.
Insights
Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) offers comparable long-term outcomes for elderly patients (≥70 years) compared to younger individuals. This spinal fusion technique effectively improves pain, disability, and quality of life in older adults.
Area of Science:
- Orthopedics
- Neurosurgery
- Geriatric Medicine
Background:
- Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a surgical technique for spinal fusion.
- Elderly patients may benefit from MIS-TLIF due to potentially lower surgical risks and faster recovery.
- Clinical and radiological outcomes of MIS-TLIF in elderly patients require evaluation with long-term follow-up.
Purpose of the Study:
- To compare the clinical and radiological outcomes of MIS-TLIF in elderly patients (≥70 years) versus younger controls.
- To assess patient-reported outcomes (PROs) and radiographic results at a minimum 5-year follow-up.
- To evaluate the safety and efficacy of MIS-TLIF in an aging population.
Main Methods:
- Retrospective review of prospective data from 120 patients undergoing single-level MIS-TLIF for degenerative spondylolisthesis.
- Patients were divided into elderly (≥70 years, n=30) and control (<70 years, n=90) groups, matched for key demographics.
- Outcomes including Oswestry Disability Index (ODI), SF-36 scores, Visual Analogue Scale (VAS) for pain, fusion rates, adjacent segment degeneration (ASD), and revision rates were assessed up to 7.2 years.
Main Results:
- Elderly patients experienced longer hospital stays and higher readmission rates, but operative time, transfusions, and complications were similar.
- At 5-year follow-up, both groups showed comparable improvements in PROs (ODI, SF-36, VAS pain) and patient satisfaction.
- Radiographic fusion rates were similar (97% elderly vs. 94% controls), as were ASD rates (33% vs. 40%). No revisions were needed in the elderly group.
Conclusions:
- Elderly patients undergoing MIS-TLIF achieve sustained improvements in pain, disability, and quality of life comparable to younger patients.
- MIS-TLIF is a safe and effective surgical option for elderly patients with degenerative spondylolisthesis, yielding favorable long-term results.
- The study supports the use of MIS-TLIF in older adults, demonstrating comparable functional recovery and spinal stability.
