Ligamentum-preserved/temporary preserved minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar spondylolisthesis: technical note and two-years follow-up.

Introduction: MIS-TLIF is a safe and effective procedure in the treatment of lumbar degenerative disease. To avoid durotomy and nerve root injury, we modified the surgical order of MIS-TLIF such that the interbody fusion procedure was performed before the decompression procedure.

Objective: The aim of this study was to compare the clinical outcomes of modified minimally invasive transforaminal lumbar interbody fusion (Ligamentum-preserved MIS-TLIF) and routine MIS-TLIF for the treatment of single-segment lumbar spondylolisthesis.

Methods: One hundred thirty-nine patients with single-segment lumbar spondylolisthesis were separated into two groups. To avoid durotomy and nerve root injury, we modified the surgical order of MIS-TLIF such that the interbody fusion procedure was performed before the decompression procedure (group A). Sixty-seven (27 males and 40 females, with an average age of 45.2 years) underwent-modified MIS-TLIF. The affected spinal segment levels in group A were L4-5 in 39 cases and L5-S1 in 28 cases. In group B, 72 patients (34 males and 38 females, with a mean age of 47.1 years) underwent routine MIS-TLIF. Among them, 42 were affected at L4-5, and 30 were affected at L5-S1.The Japanese Orthopaedic Association (JOA) score and the visual analogue scale (VAS) scores for lower back pain (LBP) and leg pain were assessed during the postoperative follow-up, and the lumbar interbody fusion rate was evaluated by computed tomography (CT) scanning.

Results: The mean operative time, incision length, average blood loss and incision pain level were not significantly different (P>0.05) between the two groups. No nerve root or dural injuries were observed in group A. In group B, there were 2 cases of dural injury and 3 cases of nerve root injury. One patient experienced temporary numbness and weakness on dorsiflexion of the foot, which recovered in three months. No differences were identified between the two groups when postoperative JOA scores, back pain, leg pain VAS scores or the lumbar interbody fusion rate.

Conclusion: Both methods are effective in the treatment of lumbar degenerative disease. Modified MIS-TLIF (Ligamentum-preserved MIS-TLIF) is a safe and effective procedure that can significantly reduce the occurrence of injury to the dura and nerve root during decompression and the interbody fusion procedure.