J Orthop Surg Res. 2025 Nov 24. doi: 10.1186/s13018-025-06531-3. Online ahead of print.
ABSTRACT
OBJECTIVE: The aim of this study is to compare radiological and clinical outcomes between midline lumbar fusion (MIDLF) and minimally invasive transforaminal lumbar interbody fusion (MITLIF) in patients with L4/5 lumbar spinal stenosis and concomitant osteoporosis.
METHODS: A retrospective cohort study was performed involving patients with osteoporosis who underwent either MIDLF or MITLIF. Participants were stratified into two groups based on the surgical technique. Primary outcome measures included operative duration, intraoperative blood loss, postoperative hemoglobin reduction, time to extubation, length of hospital stay, postoperative complication rate, fusion rate, and radiographic parameters: lumbar lordosis (LL), intervertebral disc height (HOD), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Clinical outcomes were assessed using the Visual Analogue Scale (VAS) for back and leg pain, Japanese Orthopaedic Association (JOA) scores, and the Oswestry Disability Index (ODI).
RESULTS: The MIDLF group comprised 22 patients with a mean follow-up duration of 32.48 months, while the MITLIF group included 21 patients with a mean follow-up of 35.32 months. Both groups demonstrated statistically significant postoperative improvements in VAS, JOA, and ODI scores relative to baseline. The MIDLF group exhibited significantly higher JOA scores at 3 and 12 months postoperatively. Intraoperative blood loss was significantly lower in the MITLIF group (p < 0.021), and time to extubation was also significantly shorter (p < 0.001). Although not statistically significant, the MIDLF group exhibited reduced surgical and hospitalization durations. No significant differences were observed between groups in terms of complication or fusion rates. Radiological evaluation indicated significant postoperative improvements in LL, HOD, and SS, along with reductions in PT and PI-LL mismatch; however, no statistically significant differences were observed between the surgical techniques.
CONCLUSION: Both MIDLF and MITLIF are effective in improving sagittal alignment and alleviating symptoms in patients with L4/5 lumbar spinal stenosis and osteoporosis. MITLIF may offer perioperative advantages, including reduced intraoperative blood loss and a shorter extubation times.
PMID:41276834 | DOI:10.1186/s13018-025-06531-3
