Minimally Invasive versus Open Transforaminal Lumbar Interbody Fusion for Grade 1 Lumbar Spondylolisthesis: 60-month Follow-up from the QOD Multi-center Prospective Registry

Introduction: Though minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has short-term benefits compared to open TLIF, the impact on long-term patient-reported outcomes (PROs) is less clear. We compare the outcomes of open and MIS TLIF for grade 1 degenerative lumbar spondylolisthesis 60-months postoperatively.

Methods: We utilized the prospective Quality Outcomes Database registry and queried patients with grade 1 degenerative lumbar spondylolisthesis who underwent single-segment MIS or open TLIF. Patient-reported outcomes (PROs) were compared 60 months postoperatively—ODI, NRS Back Pain (NRS-BP), NRS Leg Pain (NRS-LP), EQ-5D, NASS Satisfaction, and cumulative reoperation rate. Multivariable models were used, adjusting for variables reaching p< 0.20 on univariate analyses.

Results: 297 patients were included: 72 MIS TLIF (24.2%) and 225 open TLIF (75.8%). 60-month follow-up was similar (MIS TLIF: 86.1% vs. open TLIF: 75.6%, p=0.06). The cohorts were similar at baseline for all PROs (p>0.05). MIS TLIF was associated with less blood loss (108.8±85.6 vs. 299.6±242.2 ml, p< 0.001), longer operations (228.2±111.5 vs. 189.6±66.5 min, p< 0.001), and a trend toward decreased length of hospitalization (2.9±1.8 vs. 3.3±1.6 days, p=0.08). Discharge disposition to home was similar (94.4% vs. 91.1%, p=0.38). Both cohorts improved significantly from baseline for all 60-month outcomes (p < 0.001). In adjusted analyses, MIS TLIF—compared to open TLIF—was associated with similar 60-month ODI, ODI change, ODI MCID achievement, NRS-BP, NRS-BP change, NRS-LP, NRS-LP change, EQ-5D, EQ-5D change, and NASS satisfaction (adjusted p>0.05). The 60-month reoperation rates did not differ significantly (MIS TLIF: 5.6% vs. open TLIF: 11.6%, p=0.14).

Conclusion : For single-level, grade 1 degenerative lumbar spondylolisthesis, MIS TLIF was associated with decreased blood loss but there was no difference in 60-month outcomes for disability, back pain, leg pain, quality of life, satisfaction, or reoperation. These results suggest that in appropriately selected patients, either procedure may be employed depending on patient and surgeon preferences.