BACKGROUND It remains unclear if minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is comparable to traditional, open TLIF because of the limitations of the prior small-sample-size, single-center studies reporting comparative effectiveness. OBJECTIVE To compare MI-TLIF to traditional, open TLIF for grade 1 degenerative lumbar spondylolisthesis in the largest study to date by sample size. METHODS We utilized the prospective Quality Outcomes Database registry and queried patients with grade 1 degenerative lumbar spondylolisthesis who underwent single-segment surgery with MI- or open TLIF methods. Outcomes were compared 24 mo postoperatively. RESULTS A total of 297 patients were included: 72 (24.2%) MI-TLIF and 225 (75.8%) open TLIF. MI-TLIF surgeries had lower mean body mass indexes (29.5 ± 5.1 vs 31.3 ± 7.0, P = .0497) and more worker's compensation cases (11.1% vs 1.3%, P < .001) but were otherwise similar. MI-TLIF had less blood loss (108.8 ± 85.6 vs 299.6 ± 242.2 mL, P < .001), longer operations (228.2 ± 111.5 vs 189.6 ± 66.5 min, P < .001), and a higher return-to-work (RTW) rate (100% vs 80%, P = .02). Both cohorts improved significantly from baseline for 24-mo Oswestry Disability Index (ODI), Numeric Rating Scale back pain (NRS-BP), NRS leg pain (NRS-LP), and Euro-Qol-5 dimension (EQ-5D) (P > .001). In multivariable adjusted analyses, MI-TLIF was associated with lower ODI (β = -4.7; 95% CI = -9.3 to -0.04; P = .048), higher EQ-5D (β = 0.06; 95% CI = 0.01-0.11; P = .02), and higher satisfaction (odds ratio for North American Spine Society [NASS] 1/2 = 3.9; 95% CI = 1.4-14.3; P = .02). Though trends favoring MI-TLIF were evident for NRS-BP (P = .06), NRS-LP (P = .07), and reoperation rate (P = .13), these results did not reach statistical significance. CONCLUSION For single-level grade 1 degenerative lumbar spondylolisthesis, MI-TLIF was associated with less disability, higher quality of life, and higher patient satisfaction compared with traditional, open TLIF. MI-TLIF was associated with higher rates of RTW, less blood loss, but longer operative times. Though we utilized multivariable adjusted analyses, these findings may be susceptible to selection bias.

中文翻译：

---

1 级退行性腰椎滑脱症的微创和开放式椎间孔椎间融合术的比较：前瞻性质量结果数据库的分析

背景 目前尚不清楚微创经椎间孔腰椎椎间融合术 (MI-TLIF) 是否可与传统的开放式 TLIF 相媲美，因为先前报告比较有效性的小样本、单中心研究存在局限性。目的 在迄今为止样本量最大的研究中，比较 MI-TLIF 与传统开放 TLIF 治疗 1 级退行性腰椎滑脱症。方法我们利用前瞻性质量结果数据库注册并询问接受 MI 或开放 TLIF 方法单节段手术的 1 级退行性腰椎滑脱患者。术后 24 个月比较结果。结果 总共包括 297 名患者：72 (24.2%) MI-TLIF 和 225 (75.8%) 开放 TLIF。MI-TLIF 手术的平均体重指数较低（29.5 ± 5.1 vs 31.3 ± 7.0，P = . 0497) 和更多工伤赔偿案例 (11.1% vs 1.3%, P < .001) 但其他方面相似。MI-TLIF 的失血量较少（108.8 ± 85.6 对 299.6 ± 242.2 毫升，P < .001），手术时间更长（228.2 ± 111.5 对 189.6 ± 66.5 分钟，P < .001），以及更高的重返工作岗位（ RTW) 率（100% 对 80%，P = .02）。两个队列的 24 个月 Oswestry 残疾指数 (ODI)、数字评定量表背痛 (NRS-BP)、NRS 腿痛 (NRS-LP) 和 Euro-Qol-5 维度 (EQ-5D) 均较基线显着改善（ P > .001）。在多变量校正分析中，MI-TLIF 与较低的 ODI（β = -4.7；95% CI = -9.3 至 -0.04；P = .048）、较高的 EQ-5D（β = 0.06；95% CI = 0.01- 0.11；P = .02）和更高的满意度（北美脊柱学会 [NASS] 的比值比 1/2 = 3.9；95% CI = 1.4-14.3；P = .02）。尽管 NRS-BP (P = .06)、NRS-LP (P = .07) 和再手术率 (P = .13) 有利于 MI-TLIF 的趋势很明显，但这些结果没有达到统计学意义。结论 对于单节段 1 级退行性腰椎滑脱症，与传统的开放式 TLIF 相比，MI-TLIF 与更少的残疾、更高的生活质量和更高的患者满意度相关。MI-TLIF 与更高的 RTW 率、更少的失血量、更长的手术时间相关。尽管我们使用了多变量调整分析，但这些发现可能容易受到选择偏倚的影响。与传统的开放式 TLIF 相比，患者满意度更高。MI-TLIF 与更高的 RTW 率、更少的失血量、更长的手术时间相关。尽管我们使用了多变量调整分析，但这些发现可能容易受到选择偏倚的影响。与传统的开放式 TLIF 相比，患者满意度更高。MI-TLIF 与更高的 RTW 率、更少的失血量、更长的手术时间相关。尽管我们使用了多变量调整分析，但这些发现可能容易受到选择偏倚的影响。