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).
Material and 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.
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2. Kelleher, M. O., Timlin, M., Persaud, O., & Rampersaud, Y. R. (2010). Success and failure of minimally invasive decompression for focal lumbar spinal stenosis in patients with and without deformity. Spine, 35(19), E981–E987. https://doi.org/10.1097/BRS.0b013e3181c46fb4
3. Resnick, D. K., Choudhri, T. F., Dailey, A. T., et al. (2005). Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. Journal of neurosurgery. Spine, 2(6), 673–678. https://doi.org/10.3171/spi.2005.2.6.0673
4. Resnick DK, Choudhri TF, Dailey AT, et al. (2005) Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 1: introduction and methodology. J Neurosurg Spine, 2:637-638. http://dx.doi.org/10.3171/spi.2005.2.6.0637
5. Harms, J. G. (1998). The unilateral, transforaminal approach for posterior lumbar interbody fusion. Oper Orthop Traumatol, 10, 90-102. https://doi.org/10.1007/s00064-006-0112-7
6. Saglam, N., Dogan, S., Ozcan, C., & Turkmen, I. (2019). Comparison of Four Different Posterior Screw Fixation Techniques for the Treatment of Thoracolumbar Junction Fractures. World neurosurgery, 123, e773–e780. https://doi.org/10.1016/j.wneu.2018.12.030
7. Harms J, Rolinger H. (1982) A one-stager procedure in operative treatment of spondylolistheses: dorsal traction-reposition and anterior fusion (author’s transl) Z Orthop Ihre Grenzgeb. 120(3), 343–347. https://doi.org/10.1055/s-2008-1051624
8. Jakoi, A. M., Pannu, G., D'Oro, A., Buser, Z., Pham, M. H., Patel, N. N., Hsieh, P. C., Liu, J. C., Acosta, F. L., Hah, R., & Wang, J. C. (2017). The Clinical Correlations between Diabetes, Cigarette Smoking and Obesity on Intervertebral Degenerative Disc Disease of the Lumbar Spine. Asian spine journal, 11(3), 337–347. https://doi.org/10.4184/asj.2017.11.3.337
9. Taher, F., Essig, D., Lebl, D. R., Hughes, A. P., Sama, A. A., Cammisa, F. P., & Girardi, F. P. (2012). Lumbar degenerative disc disease: current and future concepts of diagnosis and management. Advances in orthopedics, 2012, 970752. https://doi.org/10.1155/2012/970752
10. Resnick, D. K., Choudhri, T. F., Dailey, A. T. et. al (2005). Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: fusion in patients with stenosis and spondylolisthesis. Journal of neurosurgery. Spine, 2(6), 679–685. https://doi.org/10.3171/spi.2005.2.6.0679
11. Resnick, D. K., Choudhri, T. F., Dailey, A. T. et. al. (2005). Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 10: fusion following decompression in patients with stenosis without spondylolisthesis. Journal of neurosurgery. Spine, 2(6), 686–691. https://doi.org/10.3171/spi.2005.2.6.0686
12. Çaçan, M. A., & Uçar, B. Y. (2019). What every spine surgeon should know about transforaminal lumbar interbody fusion surgery for herniated discs. International orthopaedics, 43(4), 883–889. https://doi.org/10.1007/s00264-018-4251-x
13. Deutsch, H., & Musacchio, M. J., Jr (2006). Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation. Neurosurgical focus, 20(3), E10. https://doi.org/10.3171/foc.2006.20.3.11
14. Potter, B. K., Freedman, B. A., Verwiebe, E. G., Hall, J. M., Polly, D. W., Jr, & Kuklo, T. R. (2005). Transforaminal lumbar interbody fusion: clinical and radiographic results and complications in 100 consecutive patients. Journal of spinal disorders & techniques, 18(4), 337–346. https://doi.org/10.1097/01.bsd.0000166642.69189.45
15. Berquist T. H. (2006). Imaging of the postoperative spine. Radiologic clinics of North America, 44(3), 407–418. https://doi.org/10.1016/j.rcl.2006.01.002
16. Herkowitz HN, Kurz L. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. 1991;73:802-808.
17. Barth, M., Weiss, C., & Thomé, C. (2008). Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome. Spine, 33(3), 265–272. https://doi.org/10.1097/BRS.0b013e318162018c
18. Watters, W. C., 3rd, Bono, C. M., Gilbert, T. J. et. al. (2009). An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. The spine journal : official journal of the North American Spine Society, 9(7), 609–614. https://doi.org/10.1016/j.spinee.2009.03.016
19. Cloward R. B. (1953). The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. Journal of neurosurgery, 10(2), 154–168. https://doi.org/10.3171/jns.1953.10.2.0154
20. Grob, D., Scheier, H. J., Dvorak, J., Siegrist, H., Rubeli, M., & Joller, R. (1991). Circumferential fusion of the lumbar and lumbosacral spine. Archives of orthopaedic and trauma surgery, 111(1), 20–25. https://doi.org/10.1007/BF00390187
21. Kim, S. S., Denis, F., Lonstein, J. E., & Winter, R. B. (1990). Factors affecting fusion rate in adult spondylolisthesis. Spine, 15(9), 979–984. https://doi.org/10.1097/00007632-199009000-00026
22. Kozak, J. A., & O'Brien, J. P. (1990). Simultaneous combined anterior and posterior fusion. An independent analysis of a treatment for the disabled low-back pain patient. Spine, 15(4), 322–328. https://doi.org/10.1097/00007632-199004000-00014
23. Ames, C. P., Acosta, F. L., Jr, Chi, J., Iyengar, J., Muiru, W., Acaroglu, E., & Puttlitz, C. M. (2005). Biomechanical comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion performed at 1 and 2 levels. Spine, 30(19), E562–E566. https://doi.org/10.1097/01.brs.0000180505.80347.b1
24. Mummaneni, P. V., Haid, R. W., & Rodts, G. E. (2004). 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. Journal of neurosurgery. Spine, 1(1), 24–30. https://doi.org/10.3171/spi.2004.1.1.0024
25. Ghogawala Z, Dziura J, Butler WE, et al. Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med 2016;374:1424-34
26. Buttermann G , Garvey T , Hunt A , Transfeld E , Bradford D , Boachie-Adjei O , Ogilvie J . Lumbar fusion results related to diagnosis. Spine 1998;23:116–27
2. Kelleher, M. O., Timlin, M., Persaud, O., & Rampersaud, Y. R. (2010). Success and failure of minimally invasive decompression for focal lumbar spinal stenosis in patients with and without deformity. Spine, 35(19), E981–E987. https://doi.org/10.1097/BRS.0b013e3181c46fb4
3. Resnick, D. K., Choudhri, T. F., Dailey, A. T., et al. (2005). Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. Journal of neurosurgery. Spine, 2(6), 673–678. https://doi.org/10.3171/spi.2005.2.6.0673
4. Resnick DK, Choudhri TF, Dailey AT, et al. (2005) Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 1: introduction and methodology. J Neurosurg Spine, 2:637-638. http://dx.doi.org/10.3171/spi.2005.2.6.0637
5. Harms, J. G. (1998). The unilateral, transforaminal approach for posterior lumbar interbody fusion. Oper Orthop Traumatol, 10, 90-102. https://doi.org/10.1007/s00064-006-0112-7
6. Saglam, N., Dogan, S., Ozcan, C., & Turkmen, I. (2019). Comparison of Four Different Posterior Screw Fixation Techniques for the Treatment of Thoracolumbar Junction Fractures. World neurosurgery, 123, e773–e780. https://doi.org/10.1016/j.wneu.2018.12.030
7. Harms J, Rolinger H. (1982) A one-stager procedure in operative treatment of spondylolistheses: dorsal traction-reposition and anterior fusion (author’s transl) Z Orthop Ihre Grenzgeb. 120(3), 343–347. https://doi.org/10.1055/s-2008-1051624
8. Jakoi, A. M., Pannu, G., D'Oro, A., Buser, Z., Pham, M. H., Patel, N. N., Hsieh, P. C., Liu, J. C., Acosta, F. L., Hah, R., & Wang, J. C. (2017). The Clinical Correlations between Diabetes, Cigarette Smoking and Obesity on Intervertebral Degenerative Disc Disease of the Lumbar Spine. Asian spine journal, 11(3), 337–347. https://doi.org/10.4184/asj.2017.11.3.337
9. Taher, F., Essig, D., Lebl, D. R., Hughes, A. P., Sama, A. A., Cammisa, F. P., & Girardi, F. P. (2012). Lumbar degenerative disc disease: current and future concepts of diagnosis and management. Advances in orthopedics, 2012, 970752. https://doi.org/10.1155/2012/970752
10. Resnick, D. K., Choudhri, T. F., Dailey, A. T. et. al (2005). Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: fusion in patients with stenosis and spondylolisthesis. Journal of neurosurgery. Spine, 2(6), 679–685. https://doi.org/10.3171/spi.2005.2.6.0679
11. Resnick, D. K., Choudhri, T. F., Dailey, A. T. et. al. (2005). Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 10: fusion following decompression in patients with stenosis without spondylolisthesis. Journal of neurosurgery. Spine, 2(6), 686–691. https://doi.org/10.3171/spi.2005.2.6.0686
12. Çaçan, M. A., & Uçar, B. Y. (2019). What every spine surgeon should know about transforaminal lumbar interbody fusion surgery for herniated discs. International orthopaedics, 43(4), 883–889. https://doi.org/10.1007/s00264-018-4251-x
13. Deutsch, H., & Musacchio, M. J., Jr (2006). Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation. Neurosurgical focus, 20(3), E10. https://doi.org/10.3171/foc.2006.20.3.11
14. Potter, B. K., Freedman, B. A., Verwiebe, E. G., Hall, J. M., Polly, D. W., Jr, & Kuklo, T. R. (2005). Transforaminal lumbar interbody fusion: clinical and radiographic results and complications in 100 consecutive patients. Journal of spinal disorders & techniques, 18(4), 337–346. https://doi.org/10.1097/01.bsd.0000166642.69189.45
15. Berquist T. H. (2006). Imaging of the postoperative spine. Radiologic clinics of North America, 44(3), 407–418. https://doi.org/10.1016/j.rcl.2006.01.002
16. Herkowitz HN, Kurz L. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. 1991;73:802-808.
17. Barth, M., Weiss, C., & Thomé, C. (2008). Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome. Spine, 33(3), 265–272. https://doi.org/10.1097/BRS.0b013e318162018c
18. Watters, W. C., 3rd, Bono, C. M., Gilbert, T. J. et. al. (2009). An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. The spine journal : official journal of the North American Spine Society, 9(7), 609–614. https://doi.org/10.1016/j.spinee.2009.03.016
19. Cloward R. B. (1953). The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. Journal of neurosurgery, 10(2), 154–168. https://doi.org/10.3171/jns.1953.10.2.0154
20. Grob, D., Scheier, H. J., Dvorak, J., Siegrist, H., Rubeli, M., & Joller, R. (1991). Circumferential fusion of the lumbar and lumbosacral spine. Archives of orthopaedic and trauma surgery, 111(1), 20–25. https://doi.org/10.1007/BF00390187
21. Kim, S. S., Denis, F., Lonstein, J. E., & Winter, R. B. (1990). Factors affecting fusion rate in adult spondylolisthesis. Spine, 15(9), 979–984. https://doi.org/10.1097/00007632-199009000-00026
22. Kozak, J. A., & O'Brien, J. P. (1990). Simultaneous combined anterior and posterior fusion. An independent analysis of a treatment for the disabled low-back pain patient. Spine, 15(4), 322–328. https://doi.org/10.1097/00007632-199004000-00014
23. Ames, C. P., Acosta, F. L., Jr, Chi, J., Iyengar, J., Muiru, W., Acaroglu, E., & Puttlitz, C. M. (2005). Biomechanical comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion performed at 1 and 2 levels. Spine, 30(19), E562–E566. https://doi.org/10.1097/01.brs.0000180505.80347.b1
24. Mummaneni, P. V., Haid, R. W., & Rodts, G. E. (2004). 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. Journal of neurosurgery. Spine, 1(1), 24–30. https://doi.org/10.3171/spi.2004.1.1.0024
25. Ghogawala Z, Dziura J, Butler WE, et al. Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med 2016;374:1424-34
26. Buttermann G , Garvey T , Hunt A , Transfeld E , Bradford D , Boachie-Adjei O , Ogilvie J . Lumbar fusion results related to diagnosis. Spine 1998;23:116–27
| Files | ||
| Issue | Vol 9 No 4 (2023) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v9i4.13933 | |
| Keywords | ||
| TLIF, laminectomy, Lumbar Canal Stenosis, Grade 1 & 2 Spondylolisthesis | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
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.
