Preliminary Results of Minimally Invasive Decompression, TLIF and Percutaneous Pedicle Screw Insertion in Stenotic Spondylolisthesis with Severe Facet Joint Osteoarthritis
|Eleftherios Archavlis1*, Mario Carvi Y Nievas2 and Peter Ulrich1|
|1Department of Neurosurgery, Sana Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Germany|
|2Department of Neurosurgery, Klinikum Frankfurt Hoechst, Akademisches Lehrkrankenhaus der Universität Frankfurt, Germany|
|Corresponding Author :||Eleftherios Archavlis
Department of Neurosurgery
Sana Klinikum Offenbach
Akademisches Lehrkrankenhaus der Universität Frankfurt
Starkenburgring 66, 63069 Offenbach, Germany
Tel: 0049 178 9160743
Fax: 0049 69 8405 3143
E-mail: [email protected]
|Received August 26, 2013; Accepted September 27, 2013; Published September 30, 2013|
|Citation: Archavlis E, Carvi y Nievas M, Ulrich P (2013) Preliminary Results of Minimally Invasive Decompression, TLIF and Percutaneous Pedicle Screw Insertion in Stenotic Spondylolisthesis with Severe Facet Joint Osteoarthritis. J Spine S5:004. doi:10.4172/2165-7939.S5-004|
|Copyright: © 2013 Archavlis E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
Object: Minimally invasive spine (MIS) procedures are increasingly being recognized as equivalent to open procedures with regard to clinical and radiographic outcomes. These techniques are also believed to result in less pain and disability in the immediate postoperative period. There are, however, little data to assess whether these procedures in combination with minimally invasive transforaminal interbody fusion (MI-TLIF) and percutaneous pedicle screw insertion are effective in complex cases of stenotic degenerative spondylolisthesis with severe facet joint osteoarthritis (FJO).
Methods: This study retrospectively reviewed all patients who underwent lumbar instrumentation, fusion and decompression for degenerative spondylolisthesis with severe stenosis and facet joint osteoarthritis (FJO) between June 2010 and June 2011. Blood loss, operative time and intraoperative complications were assessed in all surgically treated patients who were treated with MIS decompression, MI-TLIF and percutaneous transpedicular instrumentation. Clinical outcome was measured using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back pain, leg pain, and activity level. Satisfaction was assessed with VAS for satisfaction. Radiological follow-up includes x-ray films, computed tomography and in some cases magnetic tomography scan.
Results: Twenty four cases with severe stenotic changes accompanied by severe FJO were treated with minimally invasive procedure. The minimum follow-up was 6 months with a mean of 8 months. The mean preoperative ODI score was 46.8, decreasing to a mean of 23 postoperatively. The mean VAS leg and back pain scores were 67.5 improving to means of 25.8. Twenty one out of 24 cases experienced a clinical benefit according to VAS for satisfaction and ODI. Complications included wound healing disturbance (4%), CSF fistula (4%) and contralateral radiculopathy due to articular bone spurs (8%). The accuracy of pedicle screws was high and only one revision surgery was performed.
Conclusion: MIS for severe stenotic spondylolisthesis leads to adequate and safe decompression of lumbar stenosis and results in a highly significant reduction of symptoms and disability. MIS-TLIF and percutaneous pedicle screw insertion constitute a promising treatment alternative for patients with severe stenosis and facet joint osteoarthritis.