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Mick Perez-Cruet, M.D.

Introduction:  Long-term prospective outcomes in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MITLIF) for debilitating back pain has not been well studied.

Methods:  318 patients (mean age 63, range 19-94) who underwent MITLIF with an average 5 year follow-up (range1 to 7 years), treated for spondylolisthesis (236, 74%) or degenerative disc disease (82, 26%) causing intractable back pain. Health care quality of life measures included visual analog scale (VAS), oswestry disability index (ODI), and short from (SF-36).

Result: 196 females and 122 males were treated. Levels fused included L1-2 (n = 3, 1%), L2-3 (n = 19, 6%), L3-4 (n = 34, 11%), L4-5 (n =163, 51%), L5-S1 (n = 89, 28%), or multi-level instrumentation (n =10, 3%). Estimated blood loss and hospital stay were 128.4 ml and 4.37 days, respectively. VAS scores decreased significantly starting at 6 weeks postop. ODI scores declined from 44.1 preoperatively to 28.1 (p < .05) at one year, and 30.4 (p < .05) at 2-7 year period. SF-36 physical component scores increased from 30.3 preoperatively to 39.6 (p < .05) at one year, and 38.7 (p < .05) at 2-7 year period. SF-36 mental component scores increased from 43.7 preoperatively to 48.5 (p < .05) at one year, and 49.1 (p < .05) at 2-7 year period. Fusion rate was greater than 95% at 2-year follow up. Re-operation rate for adjacent level disease was less than 2% over the 7 year period.

Conclusions: This study presents a large longterm prospective outcomes analysis of MITLIF revealing statistically significant outcome improvements out to seven years post-operatively.
MITLIF resulted in a high rate of spinal fusion and very low rate of adjacent segment disease requiring re-operation. These results highlight the importance of focused surgery and attention to proper indications when selecting patients.

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