Recalibrage moins invasif des sténoses canalaires lombaires. À propos de 35 patients opérés en utilisant un système tubulaire de rétraction musculaire

Minimally invasive transforaminal lumbar interbody fusion through a unilateral approach and percutaneous osteosynthesis

OBJECTIVES

To assess a surgical technique and the postoperative outcomes of a consecutive series of 22 patients treated for degenerative lumbar spondylolisthesis (DLS) through a minimally invasive unilateral approach associating interbody fusion and percutaneous osteosynthesis.

PATIENTS AND METHODS

Twenty-two patients were included in this study, with a mean age of 60 years (range, 35-77 years). All had low-grade single-level DLS. In all cases, the technique included a posterior unilateral paramedial approach through a tubular retractor that decompressed the vertebral canal and transforaminal intervertebral cage arthrodesis. Osteosynthesis was then systematically put in place. The evaluation criteria were clinical (pain, spinal symptoms, duration of hospital stay) and radiological. The entire series was followed up for a mean of 24 months.

RESULTS

In this series, the procedure was performed with no technical problems. The mean hospital stay lasted 4.5 days. Postoperative pain assessment showed a mean VAS of 2/10 at discharge and 75% of the patients were asymptomatic at 6 months. The radiological exams showed no extrapedicular screws and the fusion rate was 95% at the last follow-up (with one patient needing surgical revision for malunion).

CONCLUSION

Transforaminal lumbar interbody fusion through a unilateral approach associated with percutaneous osteosynthesis is a reliable and effective technique in DLS surgery. The clinical and radiological results are encouraging, with low morbidity and a fusion rate comparable to conventional techniques. However, a longer follow-up will be necessary so as to assess the long-term results of this surgical strategy.