Journal of Krishna Institute of Medical Sciences University (Jan 2023)
Comparative study of open Transforaminal Lumbar Interbody Fusion (TLIF) and Minimally Invasive Transforaminal Lumbar Interbody Fusion (MISTLIF) based on clinical outcome, radiological outcome, tissue injury markers and radiation exposure
Abstract
Background: Spondylolisthesis refers to forward slippage of one vertebral body with respect to the one beneath it. Spondylolisthesis is treated with spinal fusion which can be open spinal fusion or minimally invasive fusion. Minimal Invasive Transforaminal Lumbar Interbody Fusion (MISTLIF), is the most popular type of minimally invasive fusion. No consensus is available regarding best type of fusion surgery till date. Aim and Objectives: To evaluate the clinicoradiological outcome, changes in tissue injury markers and radiation exposure between open TLIF and MIS TLIF. Materials and Methods: A clinical series of 70 patients with symptomatic lumbar spondylolisthesis who underwent surgery (Open TLIF-35, MISTLIF-35) were included in the study. Clinical outcome and the function were assessed using the Visual Analogue Scale (VAS) score for pain and the Oswestry Disability Index (ODI). Serum levels of creatine phosphokinase and C-reactive protein were measured on pre-operative day and post-operatively on days 1 and 3. Radiation exposure levels were quantified with a dosimeter which was worn by operating surgeon over the lead apron. Results: A total of seventy patients (Open TLIF-35, MISTLIF-35) were included in the study. The preoperative demographic, clinical, biochemical, and radiological parameters were comparable in both the groups. The patients in both the groups had significant improvement in VAS and ODI scores postoperatively. The fusion rates in the follow up were same in both the groups. The patients in MISTLIF group scored better over the open TLIF group in terms of intraoperative blood loss, requirement for blood transfusions, requirement of postoperative analgesia and muscle injury markers. The rate of complications was more in the open TLIF group; however, the radiation exposure was less in the open group. Conclusion: The postoperative VAS, ODI scores and fusion rates were similar in both groups. MISTLIF results in less tissue damage which accounts for lesser blood loss, shorter hospital stay and lesser postoperative analgesia requirements with increased radiation exposure being a shortcoming.
