BACKGROUND A variety of surgical techniques can be used to achieve lumbar spinal fusion for management of degenerative conditions. Transforaminal lumbar interbody fusion (TLIF) is the most popular technique; however, midline lumbar interbody fusion (MIDLIF) is a valid alternative to the more traditional pedicle screw trajectory with potential advantages. The aim of this study is to evaluate the clinical outcomes from a cohort of patients submitted to MIDLIF in a single hospital during the surgical team's initial learning period. METHODS The first 30 consecutive patients who underwent single- or two-level MIDLIF surgery for lumbar degenerative disease were included in this retrospective study. Patients' demographics, surgical data, length of hospitalisation, and perioperative complications were analysed. Preoperative and postoperative radiographic parameters were obtained. Validated questionnaires, Core Outcome Measure Index for the back, Euro-QoL 5-Dimensional Questionnaire, and Oswestry Disability Index, were used for clinical assessment. RESULTS Mean surgery time was 278.53 ± 82.16 min and mean hospitalisation time was 6.17 ± 3.51 days. Six patients experienced complications, four of which being dural tears with no consequences, and two required reoperations during the mean follow-up of 25.23 ± 9.74 months. Preoperative and postoperative radiological parameters did not demonstrate significant differences. All clinical parameters significantly improved after surgery (p < 0.001). A complexity score was developed to more accurately compare the different procedures, and it strongly correlated with surgery duration (r = 0.719, p < 0.001). Furthermore, a moderate correlation was found between a developed Duration Index and the patient's order number (r = - 0.539, p = 0.002). CONCLUSIONS In our initial experience, MIDLIF showed to be effective in significantly improving the patients' functional status, pain scores, and quality of life. The technique seems safe, with an acceptably low complication rate. Hence, MIDLIF can be considered as a promising alternative to more traditional TLIF and PLIF techniques even at the beginning of the learning curve.

中文翻译：

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带皮质螺钉的中线腰椎椎间融合术（MIDLIF）：初步经验和学习曲线。

背景技术可以使用多种外科技术来实现腰椎融合术，以治疗退行性疾病。经椎间孔腰椎椎间融合术（TLIF）是最流行的技术。然而，中线腰椎椎间融合术（MIDLIF）是较传统的椎弓根螺钉轨迹的有效替代方法，具有潜在的优势。这项研究的目的是评估在外科团队最初学习期间在同一家医院接受MIDLIF治疗的一组患者的临床结果。方法这项回顾性研究纳入了连续30例行单次或二级腰椎退行性疾病的MIDLIF手术的患者。分析了患者的人口统计学，手术数据，住院时间和围手术期并发症。获得了术前和术后的影像学参数。经过验证的问卷，背部的核心结果测量指数，Euro-QoL 5维问卷和Oswestry残疾指数用于临床评估。结果平均手术时间为278.53±82.16分钟，平均住院时间为6.17±3.51天。6例患者发生了并发症，其中4例为硬脑膜撕裂，无任何后果，2例在平均随访25.23±9.74个月期间需要再次手术。术前和术后放射学参数无明显差异。手术后所有临床参数均明显改善（p <0.001）。开发了复杂度评分以更准确地比较不同的程序，它与手术持续时间密切相关（r = 0.719，p <0.001）。此外，在发展的持续时间指数与患者的订单编号之间发现了中等相关性（r =-0.539，p = 0.002）。结论根据我们的初步经验，MIDLIF可以有效地改善患者的功能状态，疼痛评分和生活质量。该技术似乎安全，并发症发生率低。因此，即使在学习曲线开始时，MIDLIF仍被认为是更传统的TLIF和PLIF技术的有希望的替代方法。并发症发生率较低。因此，即使在学习曲线开始时，MIDLIF仍被认为是更传统的TLIF和PLIF技术的有希望的替代方法。并发症发生率较低。因此，即使在学习曲线开始时，MIDLIF仍被认为是更传统的TLIF和PLIF技术的有希望的替代方法。