MIS-D Versus MIS-TLIF for the Treatment of Lumbar Spinal Stenosis
MIS-D Versus MIS-TLIF for the Treatment of Lumbar Spinal Stenosis
The purpose of this study is to evaluate the effectiveness of two minimal invasive spine
 surgery, minimally invasive spinal decompression (MIS-D) and minimally invasive spinal
 decompression and fusion (MIS-TLIF), for patients diagnosed with lumbar spinal stenosis in
 terms of clinical outcomes, complications, reoperations, and other perioperative data.
Lumbar spinal stenosis (LSS) is one of the most common degenerative spine diseases in older
 people and is associated with mechanical low back pain, radiculopathy and/or neurological
 claudication. The results of The Spine Patient Outcomes Research Trial (SPORT) reported that,
 surgical treatment in these patients led to significantly greater improvement in pain and
 function than nonsurgical treatment. Nowadays, decompression with instrumented or
 non-instrumented fusion is commonly practiced which is regarded as the "gold standard"
 surgery for LSS.

 Over the last two decades, several retrospective studies comparing the surgical outcomes of
 decompression alone and decompression plus fusion for LSS have been published. Most of the
 studies concluded that decompression plus fusion had better clinical outcomes compared with
 decompression alone. However, in 2016, two randomized control trials (RCT) about LSS were
 published in the New England Journal of Medicine (NEJM) and raised some serious questions.
 The results of both studies showed that fusion did not have much additional value for
 patients with stable LSS, and moreover, it might be regard as an overcautious and unnecessary
 treatment, which were contradictory to most of the previous studies.

 Over the past few years, minimally invasive spine surgery (MISS) has been improving rapidly
 due to the development of related instruments, more experienced surgeons, and patients'
 demands. Compared with open spine surgery, MISS has already proved to be associated with less
 surgical trauma and rapid recovery with similar clinical outcomes. Minimally invasive spinal
 decompression (MIS-D) and minimally invasive spinal decompression and fusion (MIS-TLIF) have
 been performed widely for the treatment of LSS. However, there is no previous study comparing
 MIS-D to MIS-TLIF in terms of clinical outcomes, complications, reoperations, and other
 perioperative data. Therefore, a randomized controlled trial comparing these 2 common MISS
 techniques is warranted.
Inclusion Criteria:

 -  Intermittent claudication with pain or numbness or weakness of lower limb(s) with or
 without low back pain

 -  An imaging study (MRI or CT) showing single level lumbar spinal stenosis

 Exclusion Criteria:

 -  Insufficient conservative treatment (6 weeks)

 -  Cauda equina syndrome or progressive neurologic deficit requiring urgent surgical
 intervention

 -  Previous spinal surgery

 -  Other comorbid conditions that contraindicating surgery

 -  Possible pregnancy that contraindicating radiological examination

 -  Age less than 18 years old

 -  Combination with 2°spondylolisthesis or segmental instability (slip distance >4mm or
 angle change >10° in dynamic plain film)

 -  Combination with other spinal disorder requiring advanced surgery (such as lumbar
 stenosis, spondylolisthesis, deformity, fracture, infection, tumor and so on)

 -  Equal to or more than two responsible level