Minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a technical description and review of the literature
Minimally invasive spine surgery (MISS) has been increasingly advocated during the last decade with new studies being reported every year. Minimally invasive spine procedures, such as minimally invasive transforaminal interbody fusion (MI-TLIF), have been introduced to reduce approach-related muscle trauma, to minimise blood loss, and to achieve faster wound healing, quicker ambulation and earlier patient discharge.
The aim of this article was to give a comprehensive review of the available English literature comparing open TLIF with MI-TLIF techniques published or available online between 1990 and 2014 as identified by an electronic database search on http://www.ncbi.nlm.nih.gov/pubmed. Fourteen relevant studies comparing MI-TLIF and open TLIF cohorts could be identified.
Results and conclusion
MI-TLIF seems to be a valid alternative to open TLIF. Both methods yield good clinical results with similar improvements of Oswestry Disability Index (ODI) and visual analogue scale (VAS) on follow-up. There seems to be no significant differences in clinical outcome and fusion rates on comparison. These results are consistent throughout all reported studies in this review. The most pronounced benefits of MI-TLIF are a significant reduction of blood loss, shorter lengths of hospital stay (LOHS) and lower surgical site infection rates. On the downside, MI-TLIF seems to be associated with significantly higher intraoperative radiation doses, a shallow learning curve, at least in the beginning, longer operating times and potentially more frequent implant failures/cage displacements and revision surgeries.
KeywordsSpine surgery Minimally invasive Transforaminal lumbar interbody fusion
- 1.Adogwa O, Johnson K, Min ET, Issar N, Carr KR, Huang K, Cheng J (2012) Extent of intraoperative muscle dissection does not affect long-term outcomes after minimally invasive surgery versus open-transforaminal lumbar interbody fusion surgery: A prospective longitudinal cohort study. Surg Neurol Int 3:S355–S361CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Authors on behalf of I, Stewart FA, Akleyev AV, Hauer-Jensen M, Hendry JH, Kleiman NJ, Macvittie TJ, Aleman BM, Edgar AB, Mabuchi K, Muirhead CR, Shore RE, Wallace WH (2012) ICRP publication 118: ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs—threshold doses for tissue reactions in a radiation protection context. Ann ICRP 41:1–322Google Scholar
- 5.Brodano GB, Martikos K, Lolli F, Gasbarrini A, Cioni A, Bandiera S, Di Silvestre M, Boriani S, Greggi T (2013) Transforaminal lumbar interbody fusion in degenerative disc disease and spondylolisthesis grade I: minimally invasive versus open surgery. J Spinal Disord Tech 33(3):269–275Google Scholar
- 8.Cloward RB (1981) Spondylolisthesis: treatment by laminectomy and posterior interbody fusion. Clin Orthop Relat Res 154:74–82Google Scholar
- 19.Hubbe U, Sircar R, Scheiwe C, Scholz C, Kogias E, Kruger MT, Volz F, Klingler JH (2015) Surgeon, staff, and patient radiation exposure in minimally invasive transforaminal lumbar interbody fusion: impact of 3D fluoroscopy-based navigation partially replacing conventional fluoroscopy: study protocol for a randomized controlled trial. Trials 16:142CrossRefPubMedPubMedCentralGoogle Scholar
- 30.McGirt MJ, Parker SL, Lerner J, Engelhart L, Knight T, Wang MY (2011) Comparative analysis of perioperative surgical site infection after minimally invasive versus open posterior/transforaminal lumbar interbody fusion: analysis of hospital billing and discharge data from 5170 patients. J Neurosurg Spine 14:771–778CrossRefPubMedGoogle Scholar
- 41.Stevens KJ, Spenciner DB, Griffiths KL, Kim KD, Zwienenberg-Lee M, Alamin T, Bammer R (2006) Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies. J Spinal Disord Tech 19:77–86CrossRefPubMedGoogle Scholar
- 44.Villard J, Ryang YM, Demetriades AK, Reinke A, Behr M, Preuss A, Meyer B, Ringel F (2014) Radiation exposure to the surgeon and the patient during posterior lumbar spinal instrumentation: a prospective randomized comparison of navigated versus non-navigated freehand techniques. Spine 39:1004–1009CrossRefPubMedGoogle Scholar