• World Neurosurg · Jun 2021

    Comparative Study

    Is Unilateral Minimally Invasive Transforaminal Lumbar Interbody Fusion Sufficient in Patients with Claudication? A Comparative Matched Cohort Study.

    • Weerasak Singhatanadgige, Matus Promsuwan, Teerachat Tanasansomboon, Wicharn Yingsakmongkol, and Worawat Limthongkul.
    • Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand.
    • World Neurosurg. 2021 Jun 1; 150: e735-e740.

    ObjectiveTo evaluate clinical and radiologic outcomes between bilateral decompression using the over-the-top technique (group 1) and unilateral decompression (group 2) in patients with claudication who underwent minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF).MethodsWe enrolled patients with claudication who underwent MIS-TLIF from January 2017 to June 2019. Visual analog scale (VAS) scores and Oswestry Disability Index (ODI), walking distance, and perioperative outcomes were compared between groups. Preoperative and 3-month postoperative magnetic resonance imaging assessed changes in canal cross-sectional area, foraminal height, and lateral recess area.ResultsSixty-five consecutive patients with ≥1 year of follow-up were enrolled. VAS scores and ODI were not significantly different between groups (VAS and ODI, respectively, at 1 month follow-up, P = 0.62 and 0.88; 3 months follow-up, P = 0.96 and 0.53; 6 months follow-up, P = 0.10 and 0.85; and 12 months follow-up, P = 0.10 and 0.66). Operative time and blood loss between groups was not statistically significant (P = 0.43 and P = 0.55). There was also no difference in the length of hospital stay (P = 0.24). Canal dimensions increased in each group without significant differences between groups (cross-sectional area, P = 0.92; foraminal height [approach and contralateral side, respectively], P = 0.62 and 0.66; and lateral recess area [approach and contralateral side, respectively], P = 0.68 and 0.50).ConclusionsA unilateral approach with ipsilateral side direct decompression and contralateral indirect decompression in MIS-TLIF is sufficient for early clinical improvement in patients with claudication.Copyright © 2021 Elsevier Inc. All rights reserved.

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