• Meng-Huang Wu, Navneet Kumar Dubey, Yen-Yao Li, Ching-Yu Lee, Chin-Chang Cheng, Chung-Sheng Shi, and Tsung-Jen Huang.
• Department of Orthopedics, Taipei Medical University Hospital, No. 252, Wu-Hsing St, Taipei 11031, Taiwan; Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wu-Hsing St., Taipei 11031, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, No. 259, Wen-Hua 1st Rd., Guishan Dist., Taoyuan City 33302, Taiwan.
• Spine J. 2017 Aug 1; 17 (8): 1082-1090.

Background ContextTo date, the surgical approaches for the treatment of lumbar spondylolisthesis by transforaminal lumbar interbody fusion (TLIF) using minimally invasive spine surgery assisted with intraoperative computed tomography image-integrated navigation (MISS-iCT), fluoroscopy (MISS-FS), and conventional open surgery (OS) are debatable.PurposeThis study compared TLIF using MISS-iCT, MISS-FS, and OS for treatment of one-level lumbar spondylolisthesis.Study DesignThis is a prospective, registry-based cohort study that compared surgical approaches for patients who underwent surgical treatment for one-level lumbar spondylolisthesis.Patient SampleOne hundred twenty-four patients from January 2010 to March 2012 in a medical center were recruited.Outcome MeasuresThe outcome measures were clinical assessments, including Short-Form 12, visual analog scale (VAS), Oswestry Disability Index, Core Outcome Measurement Index, and patient satisfaction, and blood loss, hospital stay, operation time, postoperative pedicle screw accuracy, and superior-level facet violation.MethodsAll surgeries were performed by two senior surgeons together. Ninety-nine patients (40M, 59F) who had at least 2 years' follow-up were divided into three groups according to the operation methods: MISS-iCT (N=24), MISS-FS (N=23), and OS (N=52) groups. Charts and surgical records along with postoperative CT images were assessed.ResultsMISS-iCT and MISS-FS demonstrated a significantly lowered blood loss and hospital stay compared with OS group (p<.01). Operation time was significantly lower in the MISS-iCT and OS groups compared with the MISS-FS group (p=.002). Postoperatively, VAS scores at 1 year and 2 years were significantly improved in the MISS-iCT and MISS-FS groups compared with the OS groups. No significant difference in the number of pedicle screw breach (>2 mm) was found. However, a lower superior-level facet violation rate was observed in the MISS-iCT and OS groups (p=.049).ConclusionsMISS-iCT TLIF demonstrated reduced operation time, blood loss, superior-level facet violation, hospital stay, and improved functional outcomes compared with the MISS-FS and OS approaches.Copyright © 2017 Elsevier Inc. All rights reserved.

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