The unfeasible made feasible: lumbar minimally invasive hybrid stabilization with dynamic rod and mini-open TLIF.

Posterior dynamic stabilization of the lumbar spine is spreading as a viable alternative to spinal fusion, aiming to achieve an equally satisfactory clinical outcome without making the spine completely rigid. We describe the feasibility of a minimally invasive surgical technique used to implant a hybrid system and perform a mini-open (m-open) transforaminal lumbar interbody fusion (TLIF) in patients suffering from degenerative spondylolistesis and adjacent level's degenerative disc disease (DDD). METHODS: Three patients (2 females), suffering from degenerative spondylolistesis and adjacent level's DDD, underwent two level hybrid stabilization combining a rigid, circumferential fusion (with m-open TLIF) at the level involved by spondylolistesis and a dynamic stabilization at the adjacent one. Screws, hybrid rods (Isobar™ Evolution, Scient'X Alphatec Spine) as well as interbody cages were introduced using a simple minimally invasive technique. Clinical and radiological evaluation was performed pre- and post-operatively, and at 3, 6 and 12 months, respectively, using the Visual Analogue Scale (VAS) scale and the Oswestry Disability Index (ODI) questionnaire. RESULTS: Mean VAS and ODI score reduced from 8.3, preoperatively, to 5 and from 72.66 to 43.98, respectively. No surgery-related complications were observed and the mean post-operative hospitalization was 2.5 days. Post-operative and follow-up flexion-extension x-rays showed persisting motion at dynamically stabilized levels. Follow-up CT imaging confirmed interbody fusion at TLIF levels in all patients. CONCLUSION: Dynamic and hybrid stabilizations of the lumbar spine are typically performed using open surgery. This study reports the feasibility of a hybrid stabilization with m-open TLIF performed using a minimally invasive technique.