International Orthopaedics

, Volume 33, Issue 6, pp 1683–1688 | Cite as

Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience

  • Constantin SchizasEmail author
  • Nicolas Tzinieris
  • Elefterios Tsiridis
  • Victor Kosmopoulos
Original Paper


The aim of this study was to compare our experience with minimally invasive transforaminal lumbar interbody fusion (MITLIF) and open midline transforaminal lumbar interbody fusion (TLIF). A total of 36 patients suffering from isthmic spondylolisthesis or degenerative disc disease were operated with either a MITLIF (n = 18) or an open TLIF technique (n = 18) with an average follow-up of 22 and 24 months, respectively. Clinical outcome was assessed using the visual analogue scale (VAS) and the Oswestry disability index (ODI). There was no difference in length of surgery between the two groups. The MITLIF group resulted in a significant reduction of blood loss and had a shorter length of hospital stay. No difference was observed in postoperative pain, initial analgesia consumption, VAS or ODI between the groups. Three pseudarthroses were observed in the MITLIF group although this was not statistically significant. A steeper learning effect was observed for the MITLIF group.


Pedicle Screw Oswestry Disability Index Degenerative Disc Disease Posterior Lumbar Interbody Fusion Transforaminal Lumbar Interbody Fusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Le but de cette étude est de comparer notre expérience de l’arthrodèse lombaire intercorporéale transforaminale par voie mini invasive (MITLIF) ou par voie sanglante classique (TLIF). 36 patients présentant un spondylolisthésis isthmique ou discopathie dégénérative ont été traités soit par MITLIF (n = 18) soit par voie sanglante TLIF (n = 18), le suivi moyen étant respectivement de 22 et 24 mois. Le devenir clinique a été évalué selon l’échelle visuelle analogique (VAS) et le score d’Oswestry (ODI). Il n’y a pas de différence sur la durée opératoire dans les deux groupes. Le groupe MITLIF a des pertes sanguines et une durée moyenne d’hospitalisation inférieures au groupe TLIF. Il n’y a aucune différence observée sur les douleurs postopératoires, dans la consommation d’analgésiques, le score VAS ou le score ODI. Trois pseudarthroses ont été observées avec la technique MITLIF mais la différence n’est pas significative. Une courbe d’apprentissage plus pentue a été observée avec le groupe MITLIF.



Financial support was received in the form of a research grant from DePuy Spine, Inc., Raynham, Massachusetts, USA.


  1. 1.
    Beringer WF, Mobasser JP (2006) Unilateral pedicle screw instrumentation for minimally invasive transforaminal lumbar interbody fusion. Neurosurg Focus 20:E4PubMedGoogle Scholar
  2. 2.
    Deutsch H, Musacchio MJ Jr (2006) Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation. Neurosurg Focus 20:E10CrossRefPubMedGoogle Scholar
  3. 3.
    Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273PubMedGoogle Scholar
  4. 4.
    Foley KT, Gupta SK (2002) Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results. J Neurosurg 97:7–12PubMedGoogle Scholar
  5. 5.
    Harms JG, Jeszenszky D (1998) The unilateral transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol 6:88–89Google Scholar
  6. 6.
    Holly LT, Foley KT (2003) Three-dimensional fluoroscopy-guided percutaneous thoracolumbar pedicle screw placement. Technical note. J Neurosurg 99:324–329PubMedGoogle Scholar
  7. 7.
    Humphreys SC, Hodges SD, Patwardhan AG, Eck JC, Murphy RB, Covington LA (2001) Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine 26:567–571CrossRefPubMedGoogle Scholar
  8. 8.
    Isaacs RE, Podichetty VK, Santiago P, Sandhu FA, Spears J, Kelly K, Rice L, Fessler RG (2005) Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation. J Neurosurg Spine 3:98–105CrossRefPubMedGoogle Scholar
  9. 9.
    Kambin P (1992) Arthroscopic microdiscectomy. Arthroscopy 8:287–295PubMedCrossRefGoogle Scholar
  10. 10.
    Kawaguchi Y, Matsui H, Tsuji H (1994) Back muscle injury after posterior lumbar spine surgery. Part 2: histologic and histochemical analyses in humans. Spine 19:2598–2602PubMedCrossRefGoogle Scholar
  11. 11.
    Kho VK, Chen WC (2008) Posterolateral fusion using laminectomy bone chips in the treatment of lumbar spondylolisthesis. Intern Orthopaed 32(1):115–119CrossRefGoogle Scholar
  12. 12.
    Khoo LT, Palmer S, Laich DT, Fessler RG (2002) Minimally invasive percutaneous posterior lumbar interbody fusion. Neurosurgery 51:S166–S181PubMedGoogle Scholar
  13. 13.
    Kim SS, Denis F, Lonstein JE, Winter RB (1990) Factors affecting fusion rate in adult spondylolisthesis. Spine 15(9):979–984CrossRefPubMedGoogle Scholar
  14. 14.
    Mummaneni PV, Rodts GE Jr (2005) The mini-open transforaminal lumbar interbody fusion. Neurosurgery 57:256–261CrossRefPubMedGoogle Scholar
  15. 15.
    Ozgur BM, Hughes SA, Baird LC, Taylor WR (2006) Minimally disruptive decompression and transforaminal lumbar interbody fusion. Spine J 6:27–33CrossRefPubMedGoogle Scholar
  16. 16.
    Ozgur BM, Yoo K, Rodriguez G, Taylor WR (2005) Minimally-invasive technique for transforaminal lumbar interbody fusion (TLIF). Eur Spine J 14:887–894CrossRefPubMedGoogle Scholar
  17. 17.
    Ramsay CR, Wallace SA, Garthwaite PH, Monk AF, Russell IT, Grant AM (2002) Assessing the learning curve effect in health technologies. Lessons from the nonclinical literature. Int J Technol Assess Health Care 18:1–10PubMedGoogle Scholar
  18. 18.
    Scheufler KM, Dohmen H, Vougioukas VI (2007) Percutaneous transforaminal lumbar interbody fusion for the treatment of degenerative lumbar instability. Neurosurgery 60:203–212CrossRefPubMedGoogle Scholar
  19. 19.
    Schwender JD, Holly LT, Rouben DP, Foley KT (2005) Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech 18 Suppl:S1–S6Google Scholar
  20. 20.
    Suk SI, Lee CK, Kim WJ, Lee JH, Cho KJ, Kim HG (1997) Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine 22(2):210–219, discussion 219–20CrossRefPubMedGoogle Scholar
  21. 21.
    Ventafridda V, Saita L, Ripamonti C, De CF (1985) WHO guidelines for the use of analgesics in cancer pain. Int J Tissue React 7:93–96PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Constantin Schizas
    • 1
    Email author
  • Nicolas Tzinieris
    • 1
  • Elefterios Tsiridis
    • 2
  • Victor Kosmopoulos
    • 3
    • 4
  1. 1.Hôpital Orthopédique de la Suisse RomandeCentre Hospitalier Universitaire Vaudois and The University of LausanneLausanneSwitzerland
  2. 2.Orthopaedic DepartmentSt. James’ University HospitalLeedsUK
  3. 3.Bone and Joint Research Center, Department of Orthopaedic SurgeryUniversity of North Texas Health Science CenterFort WorthUSA
  4. 4.Department of Orthopaedic SurgeryJohn Peter Smith HospitalFort WorthUSA

Personalised recommendations