Volume 3 | Issue 1 | April-September 2022 | page: 14-19 | Hitesh N. Modi, Utsab Shreshtha
Authors: Hitesh N. Modi , Utsab Shreshtha 
 Department of Spine Surgery, Zydus Hospitals and Healthcare Research Pvt. Ltd., Thaltej, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Hitesh N. Modi,
Department of Spine Surgery, Zydus Hospitals and Healthcare Research Pvt. Ltd., Thaltej, Ahmedabad, Gujarat, India.
Purpose: This study aimed to evaluate pre-operative and post-operative sagittal parameters using pelvic incidence (PI), lumbar lordosis (LL), and segmental lordosis (SL) between Asian and African population who underwent minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) and open-TLIF surgeries. Study compares blood loss, operative time, and hospital stay; and evaluates disability and pain by Oswestry disability index (ODI) and visual analog scale (VAS) score, respectively, in both groups.
Methods: This retrospective study included 104 patients with an average age of 52.1 ± 12.9 years. All were operated for open-TLIF and MIS-TLIF for one- or two-level lumbar canal stenosis or spondylolisthesis. Patients were divided into two groups according to race: Asian and African. Clinical improvements were evaluated using VAS and ODI scores. Modified MacNab’s criteria were used to evaluate outcome. Estimated blood loss, hospital stay, operative time, perioperative morbidity, and complications were reviewed. On radiological parameters, patients’ LL, PI, and SL were compared between two groups.
Results: Average follow-up was 40.6 ± 13.9 months. Both groups showed significant post-operative improvement in their VAS and ODI scores in both open- and MIS-TLIF (P < 0.0001); however, comparing clinical improvement between Asian and African groups, it did not show significant difference in VAS (P = 0.103) and ODI (P = 0.077). Both groups showed significant improvement in LL and SL in both open- and MIS-TLIF (P < 0.0001); however, there was no change in PI. It did not show any significant difference in improvement in LL (P = 0.156), PI (P = 0.798), and SL (P = 0.179) between Asian and African groups. Regarding post-operative complications, there were 4 (6.9%) and 3 (6.5%) complications occurred in Asian and African population, respectively. There were no difference in complication rates in both groups (P = 0.939).
Discussion: TLIF (MIS and open) gives similar clinical outcome between Asian and African population. Sagittal parameters were higher in African population than the Asian population. Attention should be paid to predetermine the value of LL to achieve during surgery.
Keywords: Transforaminal lumbar interbody fusion, Asian versus African, Sagittal parameters, Clinical outcome.
1. Liu V, Weill D, Bhattacharya J. Racial disparities in survival after lung transplantation. Arch Surg 2011;146:286-93.
2. McClelland S 3rd, Guo H, Okuyemi KS. Morbidity and mortality following acoustic neuroma excision in the United States: analysis of racial disparities during a decade in the radiosurgery era. Neuro Oncol 2011;13:1252-9.
3. Drazin D, Shweikeh F, Lagman C, Ugiliweneza B, Boakye M. Racial disparities in elderly patients receiving lumbar spinal stenosis surgery. Global Spine J 2017;7:162-9.
4. Cahill KS, Chi JH, Day A, Claus EB. Prevalence, complications, and hospital charges associated with use of bone-morphogenetic proteins in spinal fusion procedures. JAMA 2009;302:58-66.
5. Harms J, Rolinger H. A one-stager procedure in operative treatment of spondylolistheses: Dorsal traction-reposition and anterior fusion (author’s transl). Z Orthop Ihre Grenzgeb 1982;120:343-7.
6. Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine (Phila Pa 1976) 2003;28 Suppl 15:S26-35.
7. Styf JR, Willén J. The effects of external compression by three different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans. Spine (Phila Pa 1976) 1998;23:354-8.
8. Kim CH, Lee CH, Kim KP. How high are radiation-related risks in minimally invasive transforaminal lumbar interbody fusion compared with traditional open surgery? A meta-analysis and dose estimates of ionizing radiation. Clin Spine Surg 2016;29:52-9.
9. Nandyala SV, Fineberg SJ, Pelton M, Singh K. Minimally invasive transforaminal lumbar interbody fusion: One surgeon’s learning curve. Spine J 2014;14:1460-5.
10. Ryang YM, Villard J, Obermüller T, Friedrich B, Wolf P, Gempt J, et al. Learning curve of 3D fluoroscopy image-guided pedicle screw placement in the thoracolumbar spine. Spine J 2015;15:467-76.
11. Park Y, Lee SB, Seok SO, Jo BW, Ha JW. Perioperative surgical complications and learning curve associated with minimally invasive transforaminal lumbar interbody fusion: A single-institute experience. Clin Orthop Surg 2015;7:91-6.
12. Ng CL, Pang BC, Medina PJ, Tan KA, Dahshaini S, Liu LZ. The learning curve of lateral access lumbar interbody fusion in an Asian population: A prospective study. Eur Spine J 2015;24 Suppl 3:361-8.
13. Arima H, Dimar JR 2nd, Glassman SD, Yamato Y, Matsuyama Y, Mac-Thiong JM, et al. Differences in lumbar and pelvic parameters among African American, Caucasian and Asian populations. Eur Spine J 2018;27:2990-8.
14. Jain A, Menga E, Mesfin A. Outcomes following surgical management of Cauda Equina syndrome: Does race matter? J Racial Ethn Health Disparities 2018;5:287-92.
15. Seicean A, Seicean S, Neuhauser D, Benzel EC, Weil RJ. The influence of race on short-term outcomes after laminectomy and/or fusion spine surgery. Spine (Phila Pa 1976) 2017;42:34-41.
16. Rantanen J, Hurme M, Falck B, Alaranta H, Nykvist F, Lehto M, et al. The lumbar multifidus muscle five years after surgery for a lumbar intervertebral disc herniation. Spine (Phila Pa 1976) 1993;18:568-74.
17. Sihvonen T, Herno A, Paljärvi L, Airaksinen O, Partanen J, Tapaninaho A. Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine (Phila Pa 1976) 1993;18:575-81.
18. Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976) 1996;21:941-4.
19. Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. Part 2: Histologic and histochemical analyses in humans. Spine (Phila Pa 1976) 1994;19:2598-602.
20. Mayer TG, Vanharanta H, Gatchel RJ, Mooney V, Barnes D, Judge L, et al. Comparison of CT scan muscle measurements and isokinetic trunk strength in postoperative patients. Spine (Phila Pa 1976) 1989;14:33-6.
21. Berthonnaud E, Dimnet J, Roussouly P, Labelle H. Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 2005;18:40-7.
22. Zhao J, Zhang S, Li X, He B, Ou Y, Jiang D. Comparison of minimally invasive and open transforaminal lumbar interbody fusion for lumbar disc herniation: A retrospective cohort study. Med Sci Monit 2018;24:8693-8.
23. Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 2005;30:2024-9.
24. Suk KS, Kim KT, Lee SH, Kim JM. Significance of chin-brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine (Phila Pa 1976) 2003;28:2001-5.
25. Legaye J, Duval-Beaupère G, Hecquet J, Marty C. Pelvic incidence: A fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 1998;7:99-103.
26. Burkus M, Schlégl AT, O’Sullivan I, Márkus I, Vermes C, Tunyogi-Csapó M. Sagittal plane assessment of spino-pelvic complex in a Central European population with adolescent idiopathic scoliosis: A case control study. Scoliosis Spinal Disord 2018;13:10.
27. Sullivan TB, Marino N, Reighard FG, Newton PO. Relationship between lumbar lordosis and pelvic incidence in the adolescent patient: Normal cohort analysis and literature comparison. Spine Deform 2018;6:529-36.
28. Mac-Thiong JM, Labelle H, Berthonnaud E, Betz RR, Roussouly P. Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J 2007;16:227-34.
29. Ould-Slimane M, Lenoir T, Dauzac C, Rillardon L, Hoffmann E, Guigui P, et al. Influence of transforaminal lumbar interbody fusion procedures on spinal and pelvic parameters of sagittal balance. Eur Spine J 2012;21:1200-6.
30. Recnik G, Košak R, Vengust R. Influencing segmental balance in isthmic spondylolisthesis using transforaminal lumbar interbody fusion. J Spinal Disord Tech 2013;26:246-51.
31. Massie LW, Zakaria HM, Schultz LR, Basheer A, Buraimoh MA, Chang V. Assessment of radiographic and clinical outcomes of an articulating expandable interbody cage in minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis. Neurosurg Focus 2018;44:E8.
32. Barbagallo GM, Piccini M, Alobaid A, Al-Mutair A, Albanese V, Certo F. Bilateral tubular minimally invasive surgery for low-dysplastic lumbosacral lytic spondylolisthesis (LDLLS): analysis of a series focusing on postoperative sagittal balance and review of the literature. Eur Spine J 2014;23 Suppl 6:705-13.
33. Rajakumar DV, Hari A, Krishna M, Sharma A, Reddy M. Complete anatomic reduction and monosegmental fusion for lumbar spondylolisthesis of Grade II and higher: Use of the minimally invasive “rocking” technique. Neurosurg Focus 2017;43:E12.
34. Hsieh PC, Koski TR, O’Shaughnessy BA, Sugrue P, Salehi S, Ondra S, et al. Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine 2007;7:379-86.
35. Champagne PO, Walsh C, Diabira J, Plante ME, Wang Z, Boubez G, et al. Sagittal balance correction following lumbar interbody fusion: A comparison of the three approaches. Asian Spine J 2019;13:450-8.
36. Marty C, Boisaubert B, Descamps H, Montigny JP, Hecquet J, Legaye J, et al. The sagittal anatomy of the sacrum among young adults, infants, and spondylolisthesis patients. Eur Spine J 2002;11:119-25.
|How to Cite this Article: Modi HN, Shreshtha U | Clinical and Radiological Outcome following MIS-TLIF and Open- TLIF between Asian and African Population- a Comparative Retrospective Analysis in 104 Patients | Back Bone: The Spine Journal | April-September 2022; 3(1): 14-19. https://doi.org/10.13107/bbj.2022.v03i01.034