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

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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.

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Author notes

  1. Yongzhao Zhao, Yanjie Zhu, and Hailong Zhang contributed equally to this paper.

Authors and Affiliations

  1. Orthopedic Department, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China

    Yongzhao Zhao, Yanjie Zhu, Hailong Zhang, Chuanfeng Wang, Shisheng He & Guangfei Gu

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  1. Yongzhao Zhao
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  2. Yanjie Zhu
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  3. Hailong Zhang
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  4. Chuanfeng Wang
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  6. Guangfei Gu
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Correspondence to Guangfei Gu.

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Zhao, Y., Zhu, Y., Zhang, H. et al. Comparison of bilateral versus unilateral decompression incision of minimally invasive transforaminal lumbar interbody fusion in two-level degenerative lumbar diseases. International Orthopaedics (SICOT) 42, 2835–2842 (2018). https://doi.org/10.1007/s00264-018-3974-z

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