AUSS-TLIF vs Open TLIF in Low-Grade Lumbar Spondylolisthesis
Key Takeaways
- Patients with single-segment low-grade degenerative lumbar spondylolisthesis undergoing AUSS-TLIF or open TLIF had 6-month follow-up and similar final fusion and complication patterns.
- Early low-back pain improvement favored AUSS-TLIF, while final low-back and leg-pain outcomes were not significantly different between groups.
- Perioperative burden and in-hospital analgesic use were lower with AUSS-TLIF, although operative time was longer than with open TLIF.
- Final leg-pain, slip-reduction, MacNab, and imaging/fusion outcomes were not significantly different between AUSS-TLIF and open TLIF.
In a retrospective cohort study of AUSS-TLIF versus open TLIF in low-grade degenerative lumbar spondylolisthesis at Guangyuan Central Hospital and Xi’an Honghui Hospital from September 2023 to December 2024, researchers evaluated 73 patients, including 33 treated with AUSS-TLIF and 40 with open TLIF; all patients completed 6 months of follow-up. The cohort included single-level L4/5 or L5/S1 Meyerding grade I-II degenerative lumbar spondylolisthesis (DLS) after more than 3 months of failed conservative treatment, with instability on dynamic X-ray or Pfirrmann grade IV-V degeneration on magnetic resonance imaging. Baseline comparisons showed no significant between-group differences in age, sex, lesion segment, or degree of spondylolisthesis. AUSS-TLIF used a 1.5-2 cm uni-portal arthroscopic approach, whereas open TLIF used an approximately 12-15 cm posterior midline incision. Outcomes included visual analog scale (VAS) pain scores, Oswestry Disability Index (ODI), perioperative measures, complications, MacNab ratings, analgesic use during hospitalization, and fusion by Bridwell criteria.
Both groups improved postoperatively on VAS and ODI measures. Low-back pain scores were lower with AUSS-TLIF at 3 days and 3 months than with open TLIF (p<0.05), but there was no between-group difference in low-back pain at 6 months. Leg-pain VAS did not differ significantly between groups at 3 days, 3 months, or 6 months. ODI favored AUSS-TLIF at 3 months; however, the 6-month ODI reporting was internally inconsistent, with the Results text describing a significant difference whereas the abstract and discussion described no between-group difference at 6 months.
AUSS-TLIF was associated with less blood loss, less postoperative drainage, and shorter hospital stay, while operative time was longer, with all perioperative comparisons reported as significant. Postoperative analgesic use during hospitalization was a median 3 administrations (IQR 2-4) with AUSS-TLIF versus 4 (IQR 4-5) with open TLIF; Z=-4.821; p<0.001. In the 6-month fusion and complication outcomes with AUSS-TLIF and open TLIF, fusion rates were 97% (32/33) versus 95% (38/40), and overall complication rates were 6% (2/33) versus 12.5% (5/40), with no significant between-group differences. Two cerebrospinal fluid leaks occurred in the AUSS-TLIF group, while the open TLIF group had cerebrospinal fluid leaks and postoperative infections; neither group had cage retropulsion or postoperative neurologic worsening. Slip reduction, MacNab ratings, and final imaging/fusion outcomes were comparable.
The pattern reported here favored AUSS-TLIF for perioperative recovery and earlier low-back pain measures while leaving 6-month fusion and broader final outcomes comparable between groups. The authors noted the retrospective analysis, procedure selection based mainly on surgeons’ clinical judgment, relatively small sample size, 6-month follow-up, no quantitative analysis of the learning curve, and no cost comparison. They linked the early advantages to the 1.5-2 cm uni-portal approach, less paraspinal muscle dissection, and endoscopic visualization, while also noting a steeper learning curve and longer operative time.
According to the authors, AUSS-TLIF and open TLIF produced similar short-term clinical and fusion outcomes at 6 months in this cohort of patients with single-segment low-grade DLS. AUSS-TLIF showed advantages in perioperative burden and early symptom recovery, with the tradeoff of a longer operation time.
Clinician Questions
How did AUSS-TLIF compare with open TLIF for early low-back pain in low-grade degenerative lumbar spondylolisthesis?
In patients with single-segment low-grade degenerative lumbar spondylolisthesis, investigators reported lower low-back VAS scores with AUSS-TLIF at 3 days and 3 months after surgery, but no between-group difference at 6 months.
Were fusion and complication outcomes different between AUSS-TLIF and open TLIF at 6 months?
At 6 months, fusion rates were 97% (32/33) with AUSS-TLIF and 95% (38/40) with open TLIF, while overall complication rates were 6% (2/33) and 12.5% (5/40), and neither comparison was significantly different. Event types included cerebrospinal fluid leaks in both groups and postoperative infections only in the open TLIF group.
What perioperative tradeoff was reported with AUSS-TLIF versus open TLIF in this lumbar spondylolisthesis cohort?
In this cohort of patients with single-segment low-grade degenerative lumbar spondylolisthesis, AUSS-TLIF was associated with lower intraoperative blood loss, lower postoperative drainage volume, shorter hospital stay, and fewer in-hospital analgesic administrations, but longer operative time; analgesic use was a median 3 administrations (IQR 2-4) versus 4 (IQR 4-5).
Recommended Reading
- For more on pain and opioid use after lumbar fusion: Liposomal Bupivacaine Cut Opioid Use After Lumbar Fusion