Introduction: To minimize the perioperative invasiveness and improve the quality of life, we have performed the minimally invasive lumbar posterolateral fusion (MIS‐PLF) with transcutaneous pedicle screw fixation for degenerative spondylolisthesis. This study prospectively compared the clinical result of MIS‐PLF with that of conventional PLF (Open‐PLF) with emphasis on perioperative invasiveness and patients' quality of life.
Methods: The total of sixty‐five patients received single‐level PLF for lumbar degenerative spondylolisthesis. There were thirty‐five cases of MIS‐PLF and thirty cases of Open‐PLF. The surgical technique of MIS‐PLF includes 4 cm of main incision and transcutaneous pedicle screwing and rod insertion followed by posterolateral iliac bone graft. Analyzed parameters included the operation time, intra and postoperative blood loss, Oswestry‐Disability Index(ODI), Roland‐Morris Questionarre (RMQ), JOA score, and VAS scores of low back pain.
Results: The average follow‐up period was forty‐three months postoperatively (12–47). The intra and postoperative blood loss was significantly smaller in MIS‐PLF group (180cc) when compared to open‐PLF group (479cc). The ODI and RMQ score rapidly decreased at initial two weeks postoperatively in MIS‐PLF group, which was significantly different from those in open‐PLF group. The VAS score demonstrated further rapid decreases on postoperative day 3, 5, and 14, which was significantly different from those in open‐PLF group. The fusion was obtained in all two groups, and no major complications were demonstrated.
Conclusion: The minimally invasive lumbar posterolateral fusion with transcutaneous pedicle screw system successfully decreased the perioperative invasiveness when compared to conventional open‐PLF. The reduction of postoperative pain led to early extension of ADL, demonstrating the rapid improvement of several QOL parameters.
Significance: The minimally invasive posterior lumbar fusion does not necessarily require the interbody fusion with the presented technique. Even in the minimum access surgery, the use of interbody fusion should be carefully considered based on the degree of segmental instability and spinal alignment.