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September 10, 2025

Five-year follow-up after minimally invasive transforaminal lumbar interbody fusion versus decompression alone for grade 1 spondylolisthesis: are there any differences in outcomes?

Key Points

MIS TLIF demonstrated significantly fewer reoperations than decompression, showing a 2.8% versus 15.5% rate.
Both surgical groups showed substantial improvements in patient-reported outcomes like ODI and NRS scores after 60 months.
Patients undergoing MIS TLIF had younger age and lower diabetes prevalence compared to those in the decompression cohort.
Multivariable analysis confirmed fusion significantly lowers odds of reoperation without impacting overall satisfaction scores.

Abstract

The Spinal Laminectomy Versus Instrumented Pedicle Screw trial reported the superiority of fusion compared to laminectomy alone for patients with grade 1 degenerative spondylolisthesis. However, it remains unclear if the advantages of fusion extend to using minimally invasive surgical (MIS) techniques. This study compared 60-month outcomes following minimally invasive transforaminal lumbar interbody fusion (TLIF) versus decompression for grade 1 spondylolisthesis. The authors analyzed patients who underwent single-segment MIS TLIF or MIS tubular decompression for grade 1 degenerative lumbar spondylolisthesis from the prospective Quality Outcomes Database's 12 highest enrolling sites (SpineCORe team). Uni- and multivariable analyses compared outcomes including the Oswestry Disability Index (ODI), numeric rating scale (NRS) for back pain (NRS-BP), NRS for leg pain (NRS-LP), EuroQol-5D (EQ-5D), North American Spine Society (NASS) satisfaction score, and cumulative related reoperation rate. Of 608 total patients, 143 underwent MIS TLIF (n = 72, 50.3%) or MIS decompression (n = 71, 49.7%). The overall study cohort's 60-month follow-up rate was 86.8%. The MIS TLIF cohort was significantly younger (mean 62.1 ± 10.6 vs 72.3 ± 9.7 years), had lower rates of diabetes (9.7% vs 22.5%), higher rates of private insurance utilization (65.3% vs 26.8%), was more likely to be employed preoperatively (54.2% vs 23.9%), and had higher baseline NRS-BP scores (mean 6.9 ± 2.6 vs 5.6 ± 3.2, p 0.05). MIS TLIF demonstrated significantly larger reductions in NRS-BP scores (-4.0 ± 3.5 vs -2.2 ± 3.4) and higher rates of satisfaction (NASS score 1 or 2 = 87.7% vs 74.5%; p 0.05). On multivariable analyses, fusion significantly reduced the odds of reoperation (OR 0.07, 95% CI 0.008-0.39; p = 0.006), but fusion status was neither a significant predictor of ODI, NRS-LP, NRS-BP, or EQ-5D scores, nor NASS satisfaction scores. Regardless of the surgical approach, a dorsal-based MIS technique was associated with clinical benefits in patients with grade 1 spondylolisthesis. These 60-month results demonstrate that MIS TLIF and MIS decompression are associated with similar patient-reported outcomes. However, MIS TLIF is associated with significantly fewer reoperations.

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