Outcomes of Transforaminal Lumbar Interbody Fusion Using Unilateral Versus Bilateral Interbody Cages

Conor P. Lynch; Elliot D.K. Cha; Augustus J. Rush III; Caroline N. Jadczak; Shruthi Mohan; Cara E. Geoghegan; Kern Singh

doi:10.14245/ns.2142248.124

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저자정보: Conor P. Lynch (Department of Orthopaedic Surgery Rush University Medical Center) Elliot D.K. Cha (Department of Orthopaedic Surgery Rush University Medical Center) Augustus J. Rush III (Department of Orthopaedic Surgery Rush University Medical Center) Caroline N. Jadczak (Department of Orthopaedic Surgery Rush University Medical Center) Shruthi Mohan (Department of Orthopaedic Surgery Rush University Medical Center) Cara E. Geoghegan (Department of Orthopaedic Surgery Rush University Medical Center) Kern Singh (Department of Orthopaedic Surgery Rush University Medical Center)

저널정보: 대한척추신경외과학회 Neurospine Neurospine 제18권 제4호

발행연도: 2021.12

수록면: 854 - 862 (9page)

DOI: 10.14245/ns.2142248.124

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Objective: To assess the impact of bilateral versus unilateral interbody cages on outcomes for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) procedures. Methods: A retrospective review for primary, elective, single-level MIS TLIF procedures with bilateral posterior instrumentation from 2008?2020 was performed. Patients were grouped according to unilateral or bilateral interbody cage use. Procedures performed without static interbody cages or indicated for trauma, infection, malignancy were excluded. Patient-reported outcomes (PROs) included visual analogue scale (VAS), Oswestry Disability Index, 12-item Short Form health survey physical composite score (SF-12 PCS), Patient-Reported Outcome Measurement Information System physical function (PROMIS-PF). PROs were collected preoperatively and postoperatively. Change in PROs (Δ) was calculated and compared between groups. Achievement of minimum clinically important difference (MCID) was calculated using established values from the literature. Achievement rates were compared between groups using logistic regression. Results: The study included 151 patients, with 111 unilateral and 40 bilateral cage placements. Charlson Comorbidity Index, diabetes, and insurance status differed between groups (p<0.050). Prevalence of degenerative and isthmic spondylolisthesis (both p≤0.002), operative level (p=0.003), and postoperative length of stay (p=0.022) significantly differed between groups. The unilateral group had lower 1-year arthrodesis rates (p=0.035). Preoperative VAS leg (p=0.017) and SF-12 PCS (p=0.045) were worse for the unilateral group. ΔPROMIS-PF was greater for the bilateral group at 2 years (p=0.001). Majority of patients achieved an overall MCID for all PROs, except VAS leg (bilateral group). Conclusion: While preoperative status and postoperative arthrodesis rates differed, patients achieved an MCID at similar rates regardless of use of unilateral or bilateral cages.

#Interbody cage #Instrumentation #Patient-reported outcomes #Transforaminal lumbar interbody fusion #Lumbar fusion

참고문헌 (24)

참고문헌 신청

Martin BI / 2019 / Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015 / Spine 44:369~376

Lan T / 2018 / Comparison between posterior lumbar interbody fusion and transforaminal lumbar interbody fusion for the treatment of lumbar degenerative diseases : a systematic review and meta-analysis / World Neurosurg 112:86~93

de Kunder SL / 2017 / Transforaminal lumbar interbody fusion(TLIF)versus posterior lumbar interbody fusion(PLIF)in lumbar spondylolisthesis : a systematic review and meta-analysis / Spine J 17:1712~1721

Fleege C / 2015 / The PLIF and TLIF techniques. Indication, technique, advantages, and disadvantages / Orthopade 44:114~123

Mobbs RJ / 2015 / Lumbar interbody fusion : techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF / J Spine Surg 1:2~18

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