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Speaker: MIS TLIF for L4-5 spondylolisthesis proves reliable, economical
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SAN DIEGO — Transforaminal lumbar interbody fusion or TLIF performed with a minimally invasive technique is less challenging than other approaches for the treatment of L4-5 lumbar spondylolisthesis and goes a step further than other procedures as it facilitates correction of a patient’s sagittal imbalance, John E. O’Toole, MD, MS, of Chicago, said.
At the Congress of Neurological Surgeons Annual Meeting, O’Toole and other presenters discussed options for the treatment of L4-5 spondylolisthesis, such as minimally invasive (MIS) and endoscopic decompression, extreme lateral interbody fusion and open posterior lumbar fusion.
“In patients undergoing surgery for stenosis and a degenerative spondylolisthesis, since that is what we talked about here, decompression and fusion is the most proven treatment. The most evidence sits in the camp of doing a posterior decompression fusion procedure,” O’Toole said. “However, procedure selection is based on patient-specific characteristics and I clearly think there are examples where these other procedures are more than appropriate, and perhaps even better than typical decompression and fusion, such as MIS decompression for stable grade 1 spondylolisthesis. But, in any hands, MIS TLIF offers distinctive advantages,” O’Toole said.
He noted it is well-proven from the ample evidence now available, including two recently published studies in the New England Journal of Medicine, that surgery is indicated and effective for this disorder. But whether fusion is needed on top of a decompression depends on patient factors.
The fusion component of TLIF treats a present stability in the spine, avoids iatrogenic instability and, as such, may help avoid reoperations. Interbody fusion increases the fusion rates, O’Toole added.
“One of the other reasons to consider this is cost,” he said.
Cost savings O’Toole and colleagues have seen range from $2,000 to about $9,000 per case for MIS TLIF, which they attribute to improved acute perioperative parameters, such as reduced length of stay.
After radiographic and clinical parameters are evaluated, “it is about selecting the right procedure for the patient,” O’Toole told Healio.com/Spine. “All things being equal, the TLIF is less desirable in cases of reoperation where there is a lot of scar tissue or there is a history of dural injury or postoperative neurological deficits from another surgery, for example.” – by Susan M. Rapp
Reference:
O’Toole JE. Clinical Controversies 1-L4/5 lumbar spondylolisthesis: TLIF. Presented at: Congress of Neurological Surgeons Annual Meeting; Sept. 24-28, 2016; San Diego.
Disclosure: O’Toole reports he is a consultant to Globus Medical and Pioneer Surgical and has ownership interest in TheraCell.