The Clinical Outcome of Transforaminal Lumbar Interbody Fusion and Laminectomy for Single-Level Lumbar Canal Stenosis with Grade 1 and 2 Spondylolisthesis
,
Abstract
Background: Lower back pain is a common cause of disability that affects mobility and quality of life in both adult and elderly patients. Initial management of lower back pain includes anti-inflammatory drugs, physiotherapy, analgesics, and epidural steroid infiltration. Surgery is indicated only for those patients who develop refractory back pain radiculopathy with or without weakness, and when multiple trials of conservative management failed. The two main approaches to surgical intervention include decompression (laminectomy) and decompression with fusion (TLIF).
Method: The study was done under the department of orthopedics at SRG hospital Jhalawar (Rajasthan, IN) between May 2019 and November 2022. In our study, we compared the clinical outcome of TLIF and laminectomy for single-level lumbar canal stenosis with grade 1&2 spondylolisthesis. 40 patients with Single-Level Lumbar Canal Stenosis with Grade 1&2 Spondylolisthesis were divided into 2 equal groups. Patients in both groups were followed up for 2 years.
Results: The ODI scores improved significantly postoperatively. Modified Macnab criteria, suggest the outcomes rated as excellent/good rate of 90% in TLIF and 85% in laminectomy.
Conclusion: We evaluated that TLIF procedures are associated with slightly more significant improvement in clinical outcomes in all of the scoring systems that were applied, TLIF provides early ambulation but higher cost of treatment and longer hospital stay in comparison to laminectomy. Laminectomy procedures are associated with less economic burden, lesser hospital stays, less blood loss, and less surgical duration than TLIF.
1. Ahmed SI, Javed G, Bareeqa SB, Shah A, Zubair M, Avedia RF, et al. Comparison of decompression alone versus decompression with fusion for stenotic lumbar spine: A systematic review and meta-analysis. Cureus. 2018;10(8):e3135. doi: 10.7759/cureus.3135. [PubMed: 30345192]. [PubMed Central: PMC6188214].
2. Kelleher MO, Timlin M, Persaud O, Rampersaud YR. Success and failure of minimally invasive decompression for focal lumbar spinal stenosis in patients with and without deformity. Spine (Phila Pa 1976). 2010;35(19):E981-7. doi: 10.1097/BRS.0b013e3181c46fb4. [PubMed: 20386501].
3. Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, et al. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: Lumbar fusion for disc herniation and radiculopathy. J Neurosurg Spine. 2005;2(6):673-8. doi: 10.3171/spi.2005.2.6.0673. [PubMed: 16028736].
4. Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, et al. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 1: Introduction and methodology. J Neurosurg Spine. 2005;2(6):637-8. doi: 10.3171/spi.2005.2.6.0637. [PubMed: 16028729].
5. Harms JG, Jeszenszky D. Die posteriore, lumbale, interkorporelle Fusion in unilateraler transforaminaler Technik. Oper Orthop Traumatol. 1998;10(2):90-102. [In German]. 10.1007/s00064-006-0112-7. [PubMed: 17332991].
6. Harms J, Rolinger H. A one-stager procedure in operative treatment of spondylolistheses: Dorsal traction-reposition and anterior fusion (author's transl). Z Orthop Ihre Grenzgeb. 1982;120(3):343-7. [In German]. doi: 10.1055/s-2008-1051624. [PubMed: 7113376].
7. Saglam N, Dogan S, Ozcan C, Turkmen I. Comparison of four different posterior screw fixation techniques for the treatment of thoracolumbar junction fractures. World Neurosurg. 2019;123:e773-e780. doi: 10.1016/j.wneu.2018.12.030. [PubMed: 30579033].
8. Jakoi AM, Pannu G, D'Oro A, Buser Z, Pham MH, Patel NN, et al. The clinical correlations between diabetes, cigarette smoking and obesity on intervertebral degenerative disc disease of the lumbar spine. Asian Spine J. 2017;11(3):337-47. doi: 10.4184/asj.2017.11.3.337. [PubMed: 28670401]. [PubMed Central: PMC5481588].
9. Taher F, Essig D, Lebl DR, Hughes AP, Sama AA, Cammisa FP, et al. Lumbar degenerative disc disease: current and future concepts of diagnosis and management. Adv Orthop. 2012;2012:970752. doi: 10.1155/2012/970752. [PubMed: 22567411]. [PubMed Central: PMC3335178].
10. Cacan MA, Ucar BY. What every spine surgeon should know about transforaminal lumbar interbody fusion surgery for herniated discs. Int Orthop. 2019;43(4):883-9. doi: 10.1007/s00264-018-4251-x. [PubMed: 30565176].
11. Deutsch H, Musacchio MJ. Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation. Neurosurg Focus. 2006;20(3):E10. doi: 10.3171/foc.2006.20.3.11. [PubMed: 16599416].
12. Potter BK, Freedman BA, Verwiebe EG, Hall JM, Polly DW, Kuklo
TR. Transforaminal lumbar interbody fusion: Clinical and radiographic results and complications in 100 consecutive patients. J Spinal Disord Tech. 2005;18(4):337-46. doi: 10.1097/01.bsd.0000166642.69189.45. [PubMed: 16021015].
13. Berquist TH. Imaging of the postoperative spine. Radiol Clin North Am. 2006;44(3):407-18. doi: 10.1016/j.rcl.2006.01.002. [PubMed: 16644358].
14. Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. 1991;73(6):802-8. [PubMed: 2071615].
15. Barth M, Weiss C, Thome C. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: Part 1: Evaluation of clinical outcome. Spine (Phila Pa 1976). 2008;33(3):265-72. doi: 10.1097/BRS.0b013e318162018c. [PubMed: 18303458].
16. Watters WC 3rd, Bono CM, Gilbert TJ, Kreiner DS, Mazanec DJ, Shaffer WO, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J. 2009;9(7):609-14. doi: 10.1016/j.spinee.2009.03.016. [PubMed: 19447684].
17. Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg. 1953;10(2):154-68. doi: 10.3171/jns.1953.10.2.0154. [PubMed: 13035484].
18. Grob D, Scheier HJ, Dvorak J, Siegrist H, Rubeli M, Joller R. Circumferential fusion of the lumbar and lumbosacral spine. Arch Orthop Trauma Surg. 1991;111(1):20-5. doi: 10.1007/BF00390187. [PubMed: 1772720].
19. Kim SS, Denis F, Lonstein JE, Winter RB. Factors affecting fusion rate in adult spondylolisthesis. Spine (Phila Pa 1976). 1990;15(9):979-84. doi: 10.1097/00007632-199009000-00026. [PubMed: 2259992].
20. Kozak JA, O'Brien JP. Simultaneous combined anterior and posterior fusion. An independent analysis of a treatment for the disabled low-back pain patient. Spine (Phila Pa 1976). 1990;15(4):322-8. doi: 10.1097/00007632-199004000-00014. [PubMed: 2141189].
21. Ames CP, Acosta FL, Chi J, Iyengar J, Muiru W, Acaroglu E, et al. Biomechanical comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion performed at 1 and 2 levels. Spine (Phila Pa 1976). 2005;30(19):E562-E566. doi: 10.1097/01.brs.0000180505.80347.b1. [PubMed: 16205329].
22. Mummaneni PV, Haid RW, Rodts GE. Lumbar interbody fusion: State-of-the-art technical advances. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine. 2004;1(1):24-30. doi: 10.3171/spi.2004.1.1.0024. [PubMed: 15291016].
23. Ghogawala Z, Dziura J, Butler WE, Dai F, Terrin N, Magge SN, et al. Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med. 2016;374(15):1424-34. doi: 10.1056/NEJMoa1508788. [PubMed: 27074067].
24. Buttermann GR, Garvey TA, Hunt AF, Transfeldt EE, Bradford DS, Boachie-Adjei O, et al. Lumbar fusion results related to diagnosis. Spine (Phila Pa 1976). 1998;23(1):116-27. doi: 10.1097/00007632-199801010-00024. [PubMed: 9460161].
2. Kelleher MO, Timlin M, Persaud O, Rampersaud YR. Success and failure of minimally invasive decompression for focal lumbar spinal stenosis in patients with and without deformity. Spine (Phila Pa 1976). 2010;35(19):E981-7. doi: 10.1097/BRS.0b013e3181c46fb4. [PubMed: 20386501].
3. Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, et al. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: Lumbar fusion for disc herniation and radiculopathy. J Neurosurg Spine. 2005;2(6):673-8. doi: 10.3171/spi.2005.2.6.0673. [PubMed: 16028736].
4. Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, et al. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 1: Introduction and methodology. J Neurosurg Spine. 2005;2(6):637-8. doi: 10.3171/spi.2005.2.6.0637. [PubMed: 16028729].
5. Harms JG, Jeszenszky D. Die posteriore, lumbale, interkorporelle Fusion in unilateraler transforaminaler Technik. Oper Orthop Traumatol. 1998;10(2):90-102. [In German]. 10.1007/s00064-006-0112-7. [PubMed: 17332991].
6. Harms J, Rolinger H. A one-stager procedure in operative treatment of spondylolistheses: Dorsal traction-reposition and anterior fusion (author's transl). Z Orthop Ihre Grenzgeb. 1982;120(3):343-7. [In German]. doi: 10.1055/s-2008-1051624. [PubMed: 7113376].
7. Saglam N, Dogan S, Ozcan C, Turkmen I. Comparison of four different posterior screw fixation techniques for the treatment of thoracolumbar junction fractures. World Neurosurg. 2019;123:e773-e780. doi: 10.1016/j.wneu.2018.12.030. [PubMed: 30579033].
8. Jakoi AM, Pannu G, D'Oro A, Buser Z, Pham MH, Patel NN, et al. The clinical correlations between diabetes, cigarette smoking and obesity on intervertebral degenerative disc disease of the lumbar spine. Asian Spine J. 2017;11(3):337-47. doi: 10.4184/asj.2017.11.3.337. [PubMed: 28670401]. [PubMed Central: PMC5481588].
9. Taher F, Essig D, Lebl DR, Hughes AP, Sama AA, Cammisa FP, et al. Lumbar degenerative disc disease: current and future concepts of diagnosis and management. Adv Orthop. 2012;2012:970752. doi: 10.1155/2012/970752. [PubMed: 22567411]. [PubMed Central: PMC3335178].
10. Cacan MA, Ucar BY. What every spine surgeon should know about transforaminal lumbar interbody fusion surgery for herniated discs. Int Orthop. 2019;43(4):883-9. doi: 10.1007/s00264-018-4251-x. [PubMed: 30565176].
11. Deutsch H, Musacchio MJ. Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation. Neurosurg Focus. 2006;20(3):E10. doi: 10.3171/foc.2006.20.3.11. [PubMed: 16599416].
12. Potter BK, Freedman BA, Verwiebe EG, Hall JM, Polly DW, Kuklo
TR. Transforaminal lumbar interbody fusion: Clinical and radiographic results and complications in 100 consecutive patients. J Spinal Disord Tech. 2005;18(4):337-46. doi: 10.1097/01.bsd.0000166642.69189.45. [PubMed: 16021015].
13. Berquist TH. Imaging of the postoperative spine. Radiol Clin North Am. 2006;44(3):407-18. doi: 10.1016/j.rcl.2006.01.002. [PubMed: 16644358].
14. Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. 1991;73(6):802-8. [PubMed: 2071615].
15. Barth M, Weiss C, Thome C. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: Part 1: Evaluation of clinical outcome. Spine (Phila Pa 1976). 2008;33(3):265-72. doi: 10.1097/BRS.0b013e318162018c. [PubMed: 18303458].
16. Watters WC 3rd, Bono CM, Gilbert TJ, Kreiner DS, Mazanec DJ, Shaffer WO, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J. 2009;9(7):609-14. doi: 10.1016/j.spinee.2009.03.016. [PubMed: 19447684].
17. Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg. 1953;10(2):154-68. doi: 10.3171/jns.1953.10.2.0154. [PubMed: 13035484].
18. Grob D, Scheier HJ, Dvorak J, Siegrist H, Rubeli M, Joller R. Circumferential fusion of the lumbar and lumbosacral spine. Arch Orthop Trauma Surg. 1991;111(1):20-5. doi: 10.1007/BF00390187. [PubMed: 1772720].
19. Kim SS, Denis F, Lonstein JE, Winter RB. Factors affecting fusion rate in adult spondylolisthesis. Spine (Phila Pa 1976). 1990;15(9):979-84. doi: 10.1097/00007632-199009000-00026. [PubMed: 2259992].
20. Kozak JA, O'Brien JP. Simultaneous combined anterior and posterior fusion. An independent analysis of a treatment for the disabled low-back pain patient. Spine (Phila Pa 1976). 1990;15(4):322-8. doi: 10.1097/00007632-199004000-00014. [PubMed: 2141189].
21. Ames CP, Acosta FL, Chi J, Iyengar J, Muiru W, Acaroglu E, et al. Biomechanical comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion performed at 1 and 2 levels. Spine (Phila Pa 1976). 2005;30(19):E562-E566. doi: 10.1097/01.brs.0000180505.80347.b1. [PubMed: 16205329].
22. Mummaneni PV, Haid RW, Rodts GE. Lumbar interbody fusion: State-of-the-art technical advances. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine. 2004;1(1):24-30. doi: 10.3171/spi.2004.1.1.0024. [PubMed: 15291016].
23. Ghogawala Z, Dziura J, Butler WE, Dai F, Terrin N, Magge SN, et al. Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med. 2016;374(15):1424-34. doi: 10.1056/NEJMoa1508788. [PubMed: 27074067].
24. Buttermann GR, Garvey TA, Hunt AF, Transfeldt EE, Bradford DS, Boachie-Adjei O, et al. Lumbar fusion results related to diagnosis. Spine (Phila Pa 1976). 1998;23(1):116-27. doi: 10.1097/00007632-199801010-00024. [PubMed: 9460161].
| Files | ||
| Issue | Vol 9 No 4 (2023) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v9i4.13933 | |
| Keywords | ||
| Treatment Outcome Spondylolisthesis Laminectomy Spinal Stenosis Surgical Decompression | ||
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How to Cite
1.
Sharma A, Suthar T, Mathur M, Mittal V, Sharma S, Mehta G. The Clinical Outcome of Transforaminal Lumbar Interbody Fusion and Laminectomy for Single-Level Lumbar Canal Stenosis with Grade 1 and 2 Spondylolisthesis. J Orthop Spine Trauma. 2023;9(4):175-9.
