• World Neurosurg · Jan 2014

    The effect of surgical level on self-reported clinical outcomes after minimally invasive transforaminal lumbar interbody fusion: L4-L5 versus L5-S1.

    • Cort D Lawton, Zachary A Smith, Alexander T Nixon, Nader S Dahdaleh, Albert P Wong, Ryan Khanna, Abdulwahed Barnawi, and Richard G Fessler.
    • Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA.
    • World Neurosurg. 2014 Jan 1;81(1):177-82.

    ObjectiveThe anatomic and biomechanical aspects of the L5-S1 level present unique operative challenges compared with the L4-L5 level. However, it has not been determined if self-reported outcomes and complications are different between patients treated with a minimally invasive transforaminal lumbar interbody fusion at these specific levels.MethodsThere were 36 consecutive patients identified who were treated with a minimally invasive transforaminal lumbar interbody fusion procedure. Surgical indications included spondylolisthesis (grade 1 or 2) and degenerative disk disease with associated clinical symptoms. Patients completed a visual analog scale (VAS) for their back and leg and Oswestry Disability Index preoperatively and postoperatively. Outcomes were compared between patients with L4-L5 involvement and patients with L5-S1 involvement. In all patients, fusion was evaluated by dynamic view flexion and extension views at 1 year. In all patients with indeterminate results or incomplete imaging, computed tomography was performed to evaluate for bridging bone and stable hardware positioning.ResultsThe surgical indications between the 2 groups were similar (χ(2) = 0.089, df = 2, P = 0.956). There was no significant difference in mean operating time, intraoperative blood loss, and hospital stay (P = 0.937, 0.627, and 0.587). There was no significant difference in the long-term postoperative questionnaire results (P = 0.819 for VAS [back], 0.626 for VAS [leg], and 0.962 for Oswestry Disability Index) or the mean preoperative to postoperative change in Cobb angle (P = 0.626) between the 2 groups. Two complications, one in each group, were a rash from an antibiotic and postoperative nausea.ConclusionsDespite differences in biomechanics and unique anatomic challenges at the L5-S1 interspace, there is no difference in self-reported outcomes for patients treated with minimally invasive transforaminal lumbar interbody fusion at the L4-L5 level compared with the L5-S1 level.Copyright © 2014 Elsevier Inc. All rights reserved.

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