Abstract Background: The objective of our study is to compare the functional and radiological outcomes between a minimally invasive novel mini open interbody fusion technique (OTDF), conventional transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) for single-level lumbar degenerative spondylolisthesis. Single midline mini-incision over the top decompression and fusion is a minimally invasive surgical procedure, which involves unilateral laminotomy decompressing bilateral roots while achieving fusion without using tubular or endoscopic instruments. Materials and Methods: It is a prospective, non-randomized, preferential study undertaken in a quaternary hospital after IRB approval. Patients with single-level L4–5 lumbar degenerative spondylolisthesis who underwent instrumented lumbar interbody fusion from January 2021 to February 2023 were included in the study. Patients were segregated into three groups (NI, N2, and N3), with 32 patients in each group. N1 patients underwent over-the-top decompression and fusion (OTDF), N2 TLIF, and N3 PLIF. Functional outcomes, blood loss, and fusion rates were compared among the groups. Results: The preoperative demographics were similar across all groups. The preoperative average Oswestry Disability Index (ODI) scores in N1, N2, and N3 were 54.4, 57.2, and 57.7 respectively. During the follow-up, the ODI scores were 21.8, 31.8, and 29.6, indicating a better outcome in N1. The total blood loss during the perioperative period is calculated by measuring both the intraop blood loss as well as the blood lost in the drain tube. The average blood loss among the groups was 232 mL in N1, 523 mL in N2, and 437 mL in N3. The blood loss was lower in the N1 group; furthermore, none of the patients in the group N1 required a blood transfusion. The four patients of the groupN2 and N3 required transfusion of blood. No patients in the N1 group developed surgical site infection (SSI). There were two patients in N2 and three in N3 who had SSI. No patient in the N1 group required post-operative patient-controlled anesthesia (PCA) or morphine. In the N2 group, five patients were on patient-controlled anesthesia (PCA), and the N3 group, two patients were on PCA and two required morphine for pain management. Across the groups, no implant-related complications were seen at follow-up, and there were no non-unions. Conclusion: This study shows OTDF is better than TLIF and PLIF providing better functional outcomes, shorter hospital stays, less blood loss, and reduced post op narcotic analgesia. Radiological outcomes and fusion rates are comparable with conventional procedures. OTDF has better cosmetic appearance with single incision, comparing with tubular/ endoscopic TLIF and PLIF. This is a safe and easily replicable alternate surgical technique for lumbar degenerative spondylolisthesis.
Bashyam et al. (Fri,) studied this question.