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Prospective, multicenter study shows few differences in outcomes for XLIF, MIS TLIF
At this early stage in comparing extreme lateral lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion for the treatment of low-grade degenerative spondylolisthesis, it will be up to continued studies to determine which treatment provides better outcomes for patients, according to a presenter.
In a prospective, multicenter comparative study, Jonathan N. Sembrano, MD, and colleagues analyzed the results of 48 patients with spondylolisthesis who underwent either extreme lateral lumbar interbody fusion (XLIF) or minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).
“In XLIF vs. MIS TLIF, patient-reported pain, function and satisfaction are comparable. There is significant improvement over baseline in both groups. In the XLIF group, there is definitely a higher incidence of postoperative hip flexion weaknesses, and patients should be consented in regards to this. These were temporary and in all cases they were resolved in 6 months. Also, MIS TLIF may result in greater early postoperative subsidence, but overall, only subtle differences were identified. We need to complete a follow-up to this study,” Sembrano said.
In all, 25 patients underwent XLIF with posterior instrumentation, with bilateral pedicle screws placed percutaneously in all cases but one, and 23 patients underwent MIS TLIF at one or two lumbar levels. Patient-reported outcomes and radiographic measures were collected preoperatively and at every visit through 2 postoperative years.
The length of time for surgery favored XLIF, with mean operating times of 171 minutes vs. 186 minutes for MIS TLIF .
Complication rates were low in both groups, Sembrano said.
In 34% of the patients who underwent XLIF there was mild transient postoperative hip flexion weakness, which resolved in 6 months in all cases. There were three dural tears in the TLIF group.
“As far as the functional outcomes ,Oswestry Disability Index or ODI and back and leg pain scores, you can see that in both groups the functional scores improved from preop to postop and held on, but there was no significant difference. The baseline back pain scores were slightly higher in the XLIF group, but they both still improved and there was no difference afterwards. At the 2-week postop mark, the leg pain score was higher in the XLIF group, but it equalized after that,” Sembrano said.
Postoperative reduction of spondylolisthesis, foraminal dimensions, and lumbar lordosis were similar in the two cohorts.
In either group, the improvement in disc angle was minimal and not statistically significant, according to Sembrano. Disc height measurement, which improved in both groups, showed greater subsidence occurred in the TLIF group.
“For neurological deficits, we looked at new and preexisting deficits. As expected, there was new hip flexion weakness in the XLIF group in about a third of the patients. One hundred percent [of patients] were fully resolved by 6 months and there was no hip flexion weakness in the TLIF group. There were a few new sensory and motor deficits that have all resolved themselves. One hundred percent of preexisting deficits in the XLIF group resolved postop, and 73% resolved in the TLIF group,” Sembrano said.
Sembrano told Spine Surgery Today this initial report of the results only extended to 6 months. The assessment of patients’ fusion rates is ongoing and therefore CT was performed at 1 year to assess fusion status. – by Robert Linnehan
Reference:
Sembrano JN, et al. Paper #194. Presented at: North American Spine Society Annual Meeting; Nov. 12-15, 2014; San Francisco.
For more information:
Jonathan N. Sembrano, MD, can be reached at Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave. South, Suite R200, Minneapolis, MN 55454; email: sembr001@umn.edu.
Disclosure: Sembrano reports he receives research support from NuVasive. He reports he is on the Board of Directors for the Society of Lateral Access Surgeons, the Philippine Minnesota Medical Association and the University of the Philippines Alumni of Minnesota.