Clinical Interventions in Aging (Jan 2023)
Minimally Invasive Spinal Fusion Using Percutaneous Pedicle Screw Instrumentation Can Provide a Better Health-Related QOL in Early Stage Than Conventional Methods in the Treatment of Single-Level Degenerative Lumbar Spinal Diseases
Abstract
Masumi Iwabuchi,1 Ryoji Tominaga,1 Jun Komatsu,1,2 Osamu Shirado1 1Department of Orthopaedic and Spinal Surgery, Aizu Medical Center at Fukushima Medical University, Aizuwakamatsu, Fukushima, Japan; 2Department of Medicine for Motor Organs, Juntendo University Graduate School of Medicine, Tokyo, JapanCorrespondence: Masumi Iwabuchi, Department of Orthopaedic and Spinal Surgery, Aizu Medical Center at Fukushima Medical University, Aizuwakamatsu, Fukushima, 969-3492, Japan, Tel +81-242-75-2100, Fax +81-242-75-2568, Email [email protected]: To investigate whether the minimally invasive spinal fusion can provide the better outcome than conventional fusion surgery in the treatment of degenerative lumbar spinal diseases.Patients and Methods: One hundred and thirteen patients who had undergone single-level fusion surgery for degenerative lumbar spinal diseases were examined with a minimum of one-year follow-up. There were 56 men and 57 women with a median age of 70s ranging 47– 88. The following three-types of fusion surgery were performed; minimally invasive transforaminal interbody fusion after microscopic decompression through a unilateral approach with percutaneous pedicle screwing (MTLIF), transforaminal interbody fusion after microscopic decompression through a unilateral approach (TLIF), and posterior lumbar interbody fusion with posterolateral fusion after open decompression through a bilateral approach (PLIF). The purpose for limiting on single level degenerative spinal disease was that it would be easy to compare the surgical outcomes among the three groups.Results: There were no statistically significant differences among three groups in terms of VAS scores, RDQ scores, and all of the domains in the JOABPEQ scores at the baseline. The JOABPEQ score for pain-related disorders at 6 months after surgery was statistically significantly higher in MTLIF group than the other two groups (P = 0.023). There were no statistically significant differences in the scores of the other outcome measures among three groups in whole follow-up period.Conclusion: The current study demonstrated that the JOABPEQ score for pain-related disorders at 6 months postoperatively was significantly better in MTLIF group than in the other groups. Since lumbar degenerative diseases mostly consisted in elderly patients, less invasive surgeries are desirable. MTLIF resulted in a better health-related QOL at 6 months after surgery, and its outcomes at the final follow-up were non-numerical inferiority. The results strongly indicate that MTLIF is desirable surgery especially for elderly patients with degenerative spinal diseases.Keywords: minimally invasive spinal fusion surgery, transforaminal lumbar interbody fusion, posterior lumbar interbody fusion, posterolateral fusion, health-related QOL, surgical outcome, percutaneous pedicle screwing, CT-based navigation system
