Minimally versus conventional-invasive transforaminal lumbar interbody fusion in patients with failed back surgery syndrome

Background: Failed back surgery syndrome is an important cause of back and leg pain after spinal surgery. Transforaminal lumbar interbody fusion (TLIF) is commonly used in revision surgery for failed back surgery syndrome. In the literature, there is a lack of evidence concerning the minimally and conventional-invasive TLIF and debates are ongoing. The purpose of the present study was to compare efficacy and safety of minimally versus conventional-invasive TLIF for failed back surgery syndrome. Materials and methods: This study was conducted according to the STROBE Statement. Between 2011 and 2014, thirty patients with failed back surgery syndrome underwent TLIF. Group I (15 patients) received minimally invasive TLIF through paramedian approach using microscopy and fluoroscopy. Group II (15 patients) received conventional-invasive TLIF. Minimum follow-up was 12 months. Results: There was a significant improvement of Oswestry Disability Index (ODI) and visual analogue scale (VAS) in both groups postoperatively. There was no statistically significant difference between both groups regarding ODI, VAS, leg and back pain pre- and postoperatively. There was a tendency to better postoperative ODI and VAS scores in group I; however this did not reach the statistical significance. One case showed adjacent segment degeneration in group I. In group II, one case had screw mal-positioning with foot drop. Another case had dural injury with postoperative fistula. Conclusion: TLIF is a valuable option after failed back surgery syndrome providing statistically significant improvement postoperatively. Both minimally and conventional-invasive TLIF represent a safe and reliable treatment of patients with failed back syndrome, achieving satisfactory outcome along with low rate of complications. Although the minimally invasive TLIF scored better, these differences did not reach the threshold of significance.