Minimally invasive fusion surgery for patients with degenerative spondylolisthesis and severe lumbar spinal stenosis: a comparative study between MIDLIF and TLIF

Abstract

PURPOSE This study aims to compare midline lumbar interbody fusion (MIDLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for treatment of patients with severe stenosis and lumbar degenerative spondylolisthesis (LDS), focusing on dural tears rates, other complications, clinical results and radiological outcomes. METHODS A retrospective cohort study that included patients with severe lumbar spinal stenosis (Shizas C and D) and lumbar degenerative spondylolisthesis who underwent MIDLIF or MIS-TLIF. Propensity score matching was done for covariate balance and the groups were compared regarding surgery time, length of stay, perioperative complications, clinical results and radiological outcomes at one 1-year of follow-up. RESULTS The study included initially 80 patients, and 72 patients after matching, 36 in each group. Six patients had dural tears, four in the MIDLIF group and two in the MIS-TLIF group (p = 0.67). General complication rates and reoperations were not significantly different between the groups. Good or excellent clinical results were achieved in 75% of the MIDLIF patients and 72% of the MIS-TLIF patients (p = 0.91). Radiological parameters showed small but statistically significant (p <0.01) improvements after surgery, particularly in segmental lordosis and lumbar lordosis, which increased by approximately 2 degrees (medians of 2.0 and 1.7), while pelvic tilt decreased by 1.6 degrees and global tilt decreased by 2.6 degrees. These findings were similar for both groups. CONCLUSION Our study confirms that MIDLIF is a safe and reliable minimally invasive alternative for lumbar interbody fusion in degenerative spondylolisthesis, even in patients with severe stenosis and previous spine surgery. It seems to offer similar results to MIS-TLIF in what comes to clinical and radiological outcomes and complications.