Minimally invasive transforaminal lumbar interbody fusion for dual-segment lower lumbar degenerative disease

Introduction
Transforaminal lumbar interbody fusion (TLIF) has been widely used to treat degenerative lumbar diseases. The PIPELINE Access minimally invasive system allows reduction of the trauma to the patient during TLIF.

Aim
To present our preliminary experience with the minimally invasive TLIF (mTLIF) technique performed on the first 7 patients with dual-segment lower lumbar degenerative disease (DS-LLDD).

Material and methods
A retrospective analysis was performed on the first 7 patients with spondylolisthesis and foraminal stenosis operated upon between January 2011 and June 2013. All 7 patients underwent fusion at the L4-S1 level.

Results
The pedicle screws entered the spinal canal in 2 patients. No other intraoperative or postoperative complications occurred with the mTLIF technique. Improvement of the leading symptom in the early postoperative period (sciatica: 7/7, low back pain: 7/7) was achieved in all patients. The mean improvements in the visual analog scale scores for low back and leg pain were 5.1 and 5.7 points, respectively. The mean Oswestry Disability Index scores were 52% (range: 20–74%) before surgery and 27% (range: 10–48%) at the 3-month follow-up (mean improvement: 25%). The average hospital stay was reduced to 6 days.

Conclusions
Our initial experience suggests that the mTLIF technique is a viable method for treating DS-LLDD. Nevertheless, longer observations on larger groups of patients are needed to reliably evaluate the safety of the method and sustainability of the results.