Reoperation Rates Due to Adjacent Segment Disease Following Primary 1 to 2-Level Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion

Abstract

Study Design. Retrospective analysis of prospectively collected data. Objective. To investigate the effect of the approach of the transforaminal lumbar interbody fusion [TLIF; open vs. minimally invasive (MIS)] on reoperation rates due to ASD at 2 to 4-year follow-up. Summary of Background Data. Adjacent segment degeneration is a complication of lumbar fusion surgery, which may progress to adjacent segment disease (ASD) and cause debilitating postoperative pain potentially requiring additional operative management for relief. MIS TLIF surgery has been introduced to minimize this complication but the impact on ASD incidence is unclear. Materials and Methods. For a cohort of patients undergoing 1 or 2-level primary TLIF between 2013 and 2019, patient demographics and follow-up outcomes were collected and compared among patients who underwent open versus MIS TLIF using the Mann-Whitney U test, Fischer exact test, and binary logistic regression. Results. Two hundred thirty-eight patients met the inclusion criteria. There was a significant difference in revision rates due to ASD between MIS and open TLIFs at 2 (5.8% vs. 15.4%, P=0.021) and 3 (8% vs. 23.2%, P=0.03) year follow-up, with open TLIFs demonstrating significantly higher revision rates. The surgical approach was the only independent predictor of reoperation rates at both 2 and 3-year follow-ups (2 yr, P=0.009; 3 yr, P=0.011). Conclusions. Open TLIF was found to have a significantly higher rate of reoperation due to ASD compared with the MIS approach. In addition, the surgical approach (MIS vs. open) seems to be an independent predictor of reoperation rates.