Tomoyuki Asada, Venkat Boddapati, Arsen Omurzakov, Olivia Tuma, Kasra Araghi, Tejas Subramanian, Eric Zhao, Annika Bay, Adin M Ehrlich, Sereen Halayqeh, Adrian Lui, Andrea Pezzi, Francis Lovecchio, James Dowdell, Harvinder Sandhu, Russel Huang, Sravisht Iyer, Sheeraz A Qureshi
{"title":"MIS-TLIF Achieves Comparable Outcomes in Challenging Spondylolisthesis Cases: Radiographic Difficulty Assessed with a Novel Grading System.","authors":"Tomoyuki Asada, Venkat Boddapati, Arsen Omurzakov, Olivia Tuma, Kasra Araghi, Tejas Subramanian, Eric Zhao, Annika Bay, Adin M Ehrlich, Sereen Halayqeh, Adrian Lui, Andrea Pezzi, Francis Lovecchio, James Dowdell, Harvinder Sandhu, Russel Huang, Sravisht Iyer, Sheeraz A Qureshi","doi":"10.1097/BRS.0000000000005324","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Objective: </strong>To compare clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) among patients with different radiographical difficult spondylolisthesis.</p><p><strong>Summary of background context: </strong>High-grade vertebral slip, collapsed disc, and less mobile segment can complicate segmental parameter restoration in MIS-TLIF. Few studies have examined if MIS-TLIF can achieve comparable outcomes in these challenging cases.</p><p><strong>Materials and methods: </strong>This study included patients who underwent single-level MIS-TLIF for degenerative spondylolisthesis. Radiographical difficulty was defined using a \"difficulty point\" system: disc height (<5 mm=1point), angular flexibility at the operated level by preoperative flexion-extension standing X-ray (<5degrees=1point), and slippage rate (>25%=1 point). Patients were categorized into \"simple\" (0 point), \"moderate\" (1 point), and \"difficult\" (2-3 points) cohorts. Outcomes included radiographic parameters (postoperative disc height, segmental lordosis restoration, and slippage reduction), complications, patient-reported outcomes such as Oswestry Disability Index (ODI) from 2 weeks to 1 year postoperatively.</p><p><strong>Results: </strong>A total of 208 patients were included, with 52 in the difficult, 89 in the moderate, and 67 in the simple. The difficult cohort showed significantly greater restoration of disc height (161.0% vs. 26.5% vs. 9.3%, P<0.001), resulting in similar postoperative disc height (8.3 mm vs. 9.0 mm vs. 0.1 mm, P=0.10) and segmental lordosis at the operated level (14.5 vs. 13.0 vs. 12.5 degrees, P=0.17). Postoperative outcomes indicated a greater improvement trend in ODI in the difficult group compared to the moderate group (β= 7.3, 9=0.011), with similar minimal clinically important difference achievement rate in ODI at 1-year postoperatively (Difficult, 69.2% vs. Moderate, 62.8% vs. Simple, 54.3%, P=0.46).</p><p><strong>Conclusion: </strong>MIS-TLIF is a feasible treatment option in patients with technically challenging radiographic parameters, achieving comparable postoperative radiographical and clinical outcomes.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005324","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Study design: Retrospective analysis.
Objective: To compare clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) among patients with different radiographical difficult spondylolisthesis.
Summary of background context: High-grade vertebral slip, collapsed disc, and less mobile segment can complicate segmental parameter restoration in MIS-TLIF. Few studies have examined if MIS-TLIF can achieve comparable outcomes in these challenging cases.
Materials and methods: This study included patients who underwent single-level MIS-TLIF for degenerative spondylolisthesis. Radiographical difficulty was defined using a "difficulty point" system: disc height (<5 mm=1point), angular flexibility at the operated level by preoperative flexion-extension standing X-ray (<5degrees=1point), and slippage rate (>25%=1 point). Patients were categorized into "simple" (0 point), "moderate" (1 point), and "difficult" (2-3 points) cohorts. Outcomes included radiographic parameters (postoperative disc height, segmental lordosis restoration, and slippage reduction), complications, patient-reported outcomes such as Oswestry Disability Index (ODI) from 2 weeks to 1 year postoperatively.
Results: A total of 208 patients were included, with 52 in the difficult, 89 in the moderate, and 67 in the simple. The difficult cohort showed significantly greater restoration of disc height (161.0% vs. 26.5% vs. 9.3%, P<0.001), resulting in similar postoperative disc height (8.3 mm vs. 9.0 mm vs. 0.1 mm, P=0.10) and segmental lordosis at the operated level (14.5 vs. 13.0 vs. 12.5 degrees, P=0.17). Postoperative outcomes indicated a greater improvement trend in ODI in the difficult group compared to the moderate group (β= 7.3, 9=0.011), with similar minimal clinically important difference achievement rate in ODI at 1-year postoperatively (Difficult, 69.2% vs. Moderate, 62.8% vs. Simple, 54.3%, P=0.46).
Conclusion: MIS-TLIF is a feasible treatment option in patients with technically challenging radiographic parameters, achieving comparable postoperative radiographical and clinical outcomes.
研究设计：回顾性分析。目的：比较不同影像学表现的难治性椎体滑脱患者行微创经椎间孔腰椎椎体间融合术（MIS-TLIF）的临床疗效。背景概述：在MIS-TLIF中，高度椎体滑移、椎间盘塌陷和活动度较低的节段会使节段参数恢复复杂化。很少有研究检验MIS-TLIF是否能在这些具有挑战性的病例中取得类似的结果。材料和方法：本研究纳入了行单节段MIS-TLIF治疗退行性脊柱滑脱的患者。使用“难度点”系统定义放射难度：椎间盘高度（25%=1分）。患者被分为“简单”（0分）、“中度”（1分）和“困难”（2-3分）组。结果包括影像学参数（术后椎间盘高度、节段性前凸恢复和滑脱复位）、并发症、患者报告的术后2周至1年的Oswestry残疾指数（ODI）。结果：共纳入208例患者，其中困难52例，中度89例，单纯67例。困难队列显示椎间盘高度恢复明显更大（161.0% vs. 26.5% vs. 9.3%）。结论：MIS-TLIF是技术上具有挑战性的放射学参数患者的可行治疗选择，获得相当的术后放射学和临床结果。证据等级：3。
期刊介绍：
Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store.
Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
