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Background: The number of young patients with degenerative lumbar spondylosis is expected to increase, and with it, the number of younger patients seeking surgical treatment is likely to rise. The goals of young patients with degenerative spondylolisthesis may differ from those of older patients, but little is known about the levels of pain and function, complication rates, or radiographic union that young patients achieve after interbody fusion.Questions/purposes: (1) How likely were patients younger than 50 years to achieve a minimal clinically important difference (MCID) in improvement on any of several validated patient-reported outcomes scores after transforaminal lumbar interbody fusion for degenerative spondylolisthesis at a minimum of 2 years after surgery? (2) What proportion developed complications or underwent reoperations? (3) What proportion achieved radiographic fusion or developed adjacent-segment degeneration?Methods: Longitudinally maintained institutional registry data of patients undergoing primary, single-level, transforaminal lumbar interbody fusion for degenerative spondylolisthesis at a single institution from 2006 to 2013 were studied in this retrospective case series. Of the 96 patients who met inclusion criteria, 14% (13 of 96) were missing follow-up data, leaving 83 patients younger than 50 years with complete clinical and radiological data at a minimum of 2 years (97%, 93 of 96 had sufficient data to assess complications and radiographic fusion). The mean age of the cohort was 44 ± 7 years. Radiological parameters for each patient with spondylolisthesis were recorded. Clinical outcomes such as the numeric rating scale for back pain and leg pain, Oswestry Disability Index (ODI) and SF-36 were assessed preoperatively and postoperatively at 1, 3, 6 months and 2 years. The proportion of patients who had an improvement greater than the MCID of each outcome instrument was then calculated. The occurrence of any medical, surgical or wound complications, and reoperations for any reason were recorded. Radiographic fusion using Bridwell grading and adjacent-segment degeneration were assessed by an independent observer not involved in clinical care. The mean follow-up was 5 ± 3 years.Results: The proportions of patients younger than 50 years who achieved the MCID for the various patient-reported outcomes were 82% (68 of 83) for leg pain, 75% (62 of 83) for back pain, 87% (72 of 83) for ODI and 71% (59 of 83) for SF-36 physical component summary at 2 years. Two perioperative complications occurred, and two reoperations were performed for implant-related complications. A total of 85% (79 of 93) of young patients achieved stable fusion, 8% (seven of 93) had radiologic adjacent-segment degeneration, and one patient underwent a revision procedure.Conclusions: Young patients with lumbar degenerative spondylolisthesis commonly, but do not always, experience clinically meaningful gains in pain relief, function, and quality of life after transforaminal lumbar interbody fusion. A low risk of complications, reoperations, nonunion and adjacent-segment degeneration were also noted in this population.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Background: Although several studies have suggested that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may be especially beneficial in the elderly population due to lower operative morbidity and faster postoperative recovery, there are limited studies investigating the functional outcomes, quality of life, and satisfaction in elderly patients after MIS-TLIF. Furthermore, existing studies had substantial clinical, diagnostic, and surgical heterogeneity.Questions/purposes: We asked if elderly patients could experience comparable (1) patient-reported pain, disability and quality of life, (2) perioperative complications, and (3) radiological fusion rates as their younger counterparts after MIS-TLIF.Methods: Prospectively collected registry data of patients undergoing primary, single-level, MIS-TLIF for degenerative spondylolisthesis between 2012 and 2014 were reviewed. We included 168 patients, 39 of whom were at least 70 years old. Of the 129 patients younger than 70 years old, propensity-score matching was used to select 39 younger controls with adjustment for sex, BMI, American Society of Anesthesiologists score, and baseline clinical outcomes. Perioperative complications and radiologic data were compared.Results: There was no difference in back pain (mean difference -0.3 [95% confidence interval -1.0 to 0.5]; p = 0.52); leg pain (mean difference -0.1 [95% CI to 0.6-0.5]; p = 0.85); Oswestry Disability Index (mean difference -2.9 [95% CI -8.0 to 2.2]; p = 0.26); and SF-36 physical (mean difference 3.0 [95% CI -0.7 to 6.8]; p = 0.107); and mental component summary (mean difference 1.9 [95% CI -4.5 to 8.2]; p = 0.56); up to 2 years postoperatively; 85% of younger patients and 85% of elderly patients were satisfied (p > 0.99) while 87% and 80%, respectively, had fulfilled expectations (p = 0.36). Four perioperative adverse events occurred in each group. There was also no difference in the rate of fusion (87% in younger patients and 90% in elderly patients; p = 0.135).Conclusions: When clinical and surgical heterogeneity were minimized, elderly patients undergoing minimally invasive transforaminal lumbar interbody fusion not only had comparable rates of perioperative complications but also experienced similar improvements in pain, function, and quality of life. A high rate of satisfaction was achieved.Level Of Evidence: Level II, prognostic study. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study using prospectively collected registry data.Objectives: To evaluate the effect of obesity on patient-reported outcome measures of pain, disability, quality of life, satisfaction, and return to work after single-level minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).Summary Of Background Data: MIS-TLIF is an appealing alternative for obese patients with potentially lower complication risk. However, there is limited data investigating the influence of obesity on outcomes 5 years after MIS-TLIF.Methods: Prospectively collected registry data of 296 patients who underwent single-level MIS-TLIF at a single institution were reviewed. Patients had complete 2- and 5-year follow-up data. Patients were stratified into control (<25.0 kg/m), overweight (25.0-29.9 kg/m), and obese (≥30.0 kg/m) groups. Outcomes assessed were visual analogue scale for back pain, leg pain, Oswestry Disability Index, Short-form 36, North American Spine Society score for neurogenic symptoms, return to work (RTW), return to function (RTF), satisfaction, and expectation fulfilment. Length of operation, length of stay, and comorbidities were recorded.Results: Among the patients, 156 (52.7%) had normal weight, 108 (36.5%) were overweight, and 32 (10.8%) were obese. There was no difference in length of operation or hospitalization (P > 0.05). All three groups had comparable preoperative scores at baseline (P > 0.05). At 5 years, the control group had significantly higher PCS compared with the overweight (P = 0.043) and obese groups (P = 0.007), although the change in scores was similar (P > 0.05). The rate of MCID attainment, RTW, RTF, expectation fulfilment, and satisfaction was comparable.Conclusion: Nonobese patients had better physical well-being in the mid-term, although obese patients experienced a comparable improvement in clinical scores. Obesity had no impact on patients' ability to RTW or RTF. Equivalent proportions of patients were satisfied and had their expectations fulfilled up to 5 years after MIS-TLIF.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study using prospectively collected registry data.Objective: To determine factors which influence return-to-work (RTW) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and to determine if early RTW affects functional outcomes.Summary Of Background Data: MIS-TLIF has been associated with accelerated return to work. RTW in non-WC working-age adults after MIS-TLIF is not well understood.Methods: Prospectively collected registry data of 907 patients who underwent MIS-TLIF at a single institution from 2004 to 2013 were reviewed. One hundred ten working adults who underwent single-level MIS-TLIF with complete preoperative and 5-year postoperative follow-up data were included. Patients were assigned into Early RTW (≤60 d, n = 40) and Late RTW (>60 d, n = 70). All patients were assessed pre- and postoperatively at 2 and 5 years. Length of operation, length of stay, and comorbidities were also recorded.Results: The Early RTW group had significantly lower Oswestry Disability Index (ODI), North American Spine Society score for neurogenic symptoms (NASS NS), numerical pain rating scale (NPRS) back and leg pain scores than the Late RTW group (<0.01) There were no significant differences in age, body mass index (BMI) and prevalence of medical comorbidities (P > 0.05). In addition, there were no differences in terms of duration of surgery or length of hospitalization. There were no significant differences in ODI, NASS NS, Short-form 36 physical and mental component scores (SF-36 PCS/MCS), NPRS, satisfaction/expectation fulfilment between the Early and Late RTW groups at 2-year and 5-year follow-up. Both groups reported similar proportions that RTW without limitations and return-to-function (RTF) at 2-years and 5-years.Conclusion: Patients who RTW late have significantly poorer preoperative SF-36 physical component scores and higher ODI, NASS NS, NPRS back/leg pain scores. Surgeons should be cognizant that working adults with poorer preoperative function will tend to return to work later, but should reassure them that they will likely achieve similar clinical outcomes, satisfaction and expectation fulfilment when compared with patients who returned to work early.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]