Minimally Invasive Transforaminal Lumbar Interbody Fusion:

Background and Objectives: Low back pain is a leading cause of disability worldwide. This study evaluates perioperative and postoperative complications and outcomes between younger (<65 yr) and older (65+ yr) adults undergoing single-level and multilevel minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods: A single-institution retrospective analysis was performed on 479 patients who underwent single-level or multilevel MIS-TLIF between 1/10/2010 and 5/24/2021. Patient demographics, operative outcomes, and patient complications were recorded and stratified by age groups and fusion level. x-ray or CT evidence of radiographic fusion was assessed in patients with at least six months of follow-up. Results: No differences were found in surgical time, blood loss, or revision/fusion rates between cohorts. There was significant improvement in postoperative Karnofsky Performance Status (KPS) scores ( P <0.05) in all age and fusion groups. Older patients with multilevel fusions were more likely to have worse preoperative and postoperative KPS scores. They also experienced longer hospitalizations regardless of fusion level ( P <0.05). Conclusions: MIS-TLIF demonstrated comparable surgical outcomes in both younger and older patients with improvements in KPS. Older adults undergoing single-level procedures were more likely to experience complications, whereas complication rates in multilevel fusions were similar across age groups. Older patients tend to experience extended hospital stays regardless of levels fused. These findings provide insight into the value of complete conversations of risks and benefits while highlighting the need for medical optimization and proper patient selection for surgical intervention, especially in older patients.