Surgical Innovation: Comparative Efficacy of Navigation-Assisted Modified Minimally Invasive Transforaminal Lumbar...

To compare the efficacy of navigation-assisted modified minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and MIS-TLIF in the treatment of low-grade isthmic spondylolisthesis in the elderly.

We retrospectively included elderly patients with low-grade isthmic spondylolisthesis who underwent surgical treatment at our hospital from January 2019 to January 2022. Based on the surgical method chosen according to the patient's personal preference, the patients were divided into the modified MIS-TLIF group and the MIS-TLIF group. The modified MIS-TLIF group underwent navigation-assisted MIS-TLIF, while the MIS-TLIF group underwent conventional MIS-TLIF. A total of 54 patients (34 males and 20 females) were included in this study, with 26 cases in the modified MIS-TLIF group and 28 cases in the MIS-TLIF group. Relevant data for this study were collected by an independent observer. The demographic characteristics, including age, gender, body mass index, comorbidities, surgical level, Meyerding grade, and duration of symptoms before admission, were recorded and compared between the 2 groups. Perioperative parameters, such as operative time, intraoperative blood loss, postoperative drainage volume, bed rest time, and hospital stay, were also recorded and compared. The lumbar pain visual analog scale, Oswestry Disability Index, and lumbar Japanese Orthopaedic Association scores were recorded preoperatively and at 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively to evaluate functional recovery in both groups. At 12 months postoperatively, patient satisfaction was assessed using the Macnab criteria (with satisfaction defined as the number of excellent and good outcomes divided by the total number in the group × 100%). The rate of vertebral slippage was recorded preoperatively, 1 week postoperatively, and 12 months postoperatively. The accuracy of screw placement was evaluated by CT scan at 1 week postoperatively, and interbody fusion was assessed by CT scan at 12 months postoperatively. Surgical complications were recorded, and their incidence was calculated.

The intraoperative blood loss, postoperative drainage volume, bed rest time, and hospital stay in the modified MIS-TLIF group were less than those in the MIS-TLIF group (P < 0.05). The back pain visual analog scale, Oswestry Disability Index, and Japanese Orthopaedic Association modified MIS-TLIF groups improved significantly compared with the MIS-TLIF group at 1 week, 1 month, 3 months, and 6 months after surgery, and the differences between groups were statistically significant (P < 0.05). The excellent and good rate of modified MIS-TLIF group was higher than that of MIS-TLIF group, and the difference had statistical significance (P < 0.05). The accuracy of screw placement in the modified MIS-TLIF group was higher than that in the MIS-TLIF group, and the difference was statistically significant (P < 0.05). The fusion rate in the modified MIS-TLIF group was higher than that in the MIS-TLIF group at 12 months after surgery, and the difference was statistically significant (P < 0.05). There was no statistical difference in the incidence rate of complications between the 2 groups.

Compared with MIS-TLIF, navigation-assisted modified MIS-TLIF has the advantages of less trauma, rapid recovery, accurate screw placement, high fusion rate, high surgical satisfaction, and good safety.