MANAGEMENT OF DEGENERATIVE LUMBAR SPINE SPONDYLOLISTHESIS WITH MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION.

Pramod Vasant Lokhande, Vaibhav Bhaskar Pawar, Vijay Vasant Nemade, Tushar Sharad Date, Ganesh Tanaji Mundhe

Abstract


Background: Open Transforaminal Lumbar Interbody fusion (TLIF) is the conventional modality of treatment for Degenerative Lumbar spine spondylolisthesis. In conventional open TLIF surgery, muscles are dissected with monopolar cautery and stripped off the lamina and the facet joints. This causes significant muscle atrophy leading to postoperative back pain. Also significant bleeding occurs during the surgery. This needs blood transfusion and prolongs the hospital stay. To minimize these complications, a Minimally Invasive approach for TLIF (MIS –TLIF) has gained popularity in recent years. In this technique the muscles are not cut but split by serial dilators to access the pathology, thus reducing the amount of iatrogenic muscle and soft tissue damage. The aim of this study is to analyze the outcome of MIS-TLIF for Degenerative lumbar spine spondylolisthesis.

Methods: The study was conducted at our institute between February 2013 to November 2015.  Patients with degenerative lumbar spine disease with Grade I or Grade II   spondylolisthesis, with predominantly unilateral radicular leg pain with or without back pain and  having Progressive neurological deficit not responding to conservative modalities of treatment were included. We have excluded patients with spondylolisthesis due to other reasons than degeneration and patients presenting with bilateral leg pain. 33 patients included in the study underwent MIS TLIF surgery under general anaesthesia. Patients were assessed pre operatively, at 24 hrs. postoperatively, at 1 month, 3 months, 6 months, 12 months and 24 months postoperative follow up. Functional outcomes Was assessed with  visual analog score (VAS) and Oswestry Disability Index (ODI). Statistical analysis was done using ‘paired T test’ and ‘chi square test’.

  Results: 33 patients who fulfilled inclusion criteria were followed up till the minimum of 2 years. 3 Patients lost follow up after one year of regular follow up. Hence data of 30 patients was available for the evaluation of clinical outcome. The disability due to backache and leg pain was assessed using the Oswestry Disability index (ODI). The mean ODI in pre-operative period was 70.17(±9.24) and 1 month after surgery Mean ODI was 10 (±11.14) at 3 months and at six months mean ODI was 8.67(±14.79). At one and two year follow up mean ODI was 6.00(±13.29). 28 (93.33%) patients showed excellent results after surgery and 2 (6.66%) patients showed good results.

Conclusions: Our study observations showed that the advantages of MIS-TLIF are more than disadvantages. Hence MIS-TLIF is a viable, safe and effective modality of treatment in carefully selected patients of Degenerative Lumbar spondylolisthesis.

Keywords


Minimally Invasive, Transforaminal fusion, Lumbar spondylolisthesis.

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