Comparison of bilateral versus unilateral decompression incision of minimally invasive transforaminal lumbar interbody fusion in two-level degenerative lumbar diseases

Abstract

Purpose: To compare the efficacy and safety of two different surgical incisions for minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the management of two-level degenerative lumbar diseases. Methods: We conducted a retrospective study of 129 patients, who underwent two-level MIS-TLIF for degenerative lumbar diseases from September 2014 to December 2015. Sixty-two patients underwent MIS-TLIF with unilateral long decompression incision (group A) and 67 patients underwent MIS-TLIF with bilateral short decompression incision (group B). Demographics and peri-operative clinical data were collected from medical records. Radiographic fusion, visual analog scale for leg pain (VAS-LP), back pain (VAS-BP), the Oswestry Disability Index (ODI), and MacNab satisfaction were compared between two groups. Results: Patients in group A experienced significantly longer operative time (P = 0.019), more estimated blood loss (P = 0.002), and radiation exposure (P < 0.001) than those in group B. However, no statistical differences were detected between two groups in blood transfusion (P = 0.845) or hospital stay (P = 0.690). Besides, VAS-BP, VAS-LP, and ODI significantly improved in both groups after the surgery, but no significant differences were observed between two groups pre-operatively, three day post-operatively, or at the last follow-up. Moreover, there were no distinct differences between two groups in total complication rate (P = 0.653), fusion rate (P = 0.822), or MacNab satisfaction (P = 1.000) at the last follow-up. Conclusions: In two-level degenerative lumbar diseases, based on the bilateral decompression via unilateral approach technique, MIS-TLIF with bilateral short decompression incision could significantly reduce radiation exposure, shorten operative time, decrease blood loss, and achieve comparable clinical outcomes when compared to unilateral long decompression incision.