L’artrodesi circonferenziale selettiva mini-invasiva nel trattamento della patologia discale degenerativa lombare

  • Andrea PiazzollaEmail author
  • Davide Bizzoca
  • Viola Montemurro
  • Claudia Parato
  • Marco La Malfa
  • Biagio Moretti

Minimally invasive circumferential fusion in lumbar degenerative disc disease


Degenerative lumbar spine disease is one of the leading causes of disability worldwide. Lumbar interbody fusion (LIF) is a valid approach in the treatment of several segmental spine pathologies, including degenerative disc disease. LIF may be performed through open and minimally invasive procedures. This review aims to assess the state of the art in the field of minimally invasive spine surgery in the treatment of degenerative disc disease.


Conflitto di interesse

Gli autori Andrea Piazzolla, Davide Bizzoca, Viola Montemurro, Claudia Parato, Marco La Malfa e Biagio Moretti dichiarano di non aver alcun conflitto di interesse.

Consenso informato e conformità agli standard etici

Tutte le procedure descritte nello studio e che hanno coinvolto esseri umani sono state attuate in conformità alle norme etiche stabilite dalla dichiarazione di Helsinki del 1975 e successive modifiche. Il consenso informato è stato ottenuto da tutti i pazienti inclusi nello studio.

Human and Animal Rights

L’articolo non contiene alcuno studio eseguito su esseri umani e su animali da parte degli autori.


  1. 1.
    Ravindra VM, Senglaub SS, Rattani A et al. (2018) Degenerative lumbar spine disease: estimating global incidence and worldwide volume. Glob Spine J. Google Scholar
  2. 2.
    Cross M, Smith E, Hoy D et al. (2014) The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 73:1323–1330 CrossRefGoogle Scholar
  3. 3.
    Mobbs RJ, Phan K, Malham G et al. (2015) Lumbar interbody fusion: techniques indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J spine Surg (Hong Kong) 1:2–18 Google Scholar
  4. 4.
    Burkus JK, Schuler TC, Gornet MF, Zdeblick TA (2004) Anterior lumbar interbody fusion for the management of chronic lower back pain: current strategies and concepts. Orthop Clin North Am 35:25–32 CrossRefGoogle Scholar
  5. 5.
    Kleeman TJ, Ahn UM, Talbot-Kleeman A (2001) Laparoscopic anterior lumbar interbody fusion with rhBMP-2: a prospective study of clinical and radiographic outcomes. Spine (Phila Pa 1976) 26(24):2751–2756 CrossRefGoogle Scholar
  6. 6.
    Kim SS, Denis F, Lonstein JE, Winter RB (1990) Factors affecting fusion rate in adult spondylolisthesis. Spine (Phila Pa 1976) 15(9):979–984 CrossRefGoogle Scholar
  7. 7.
    Sorensen KH (1978) Anterior interbody lumbar spine fusion for incapacitating disc degeneration and spondylolisthesis. Acta Orthop Scand 49:269–277 CrossRefGoogle Scholar
  8. 8.
    Formica M, Berjano P, Cavagnaro L et al. (2014) Extreme lateral approach to the spine in degenerative and post traumatic lumbar diseases: selection process, results and complications. Eur Spine J 23(Suppl 6):S684–S692 CrossRefGoogle Scholar
  9. 9.
    Briggs H (1944) Chip fusion of the low back following exploration of the spinal canal. J Bone Jt Surg Am 26:125–130 Google Scholar
  10. 10.
    Suthar M, Gupta S, Bukhari S, Ponemone V (2017) Treatment of chronic non-healing ulcers using autologous platelet rich plasma: a case series. J Biomed Sci 24:1–10 CrossRefGoogle Scholar
  11. 11.
    Pimenta L, Oliveira L, Schaffa T et al. (2011) Lumbar total disc replacement from an extreme lateral approach: clinical experience with a minimum of 2 years’ follow-up. J Neurosurg Spine 14(1):38–45 CrossRefGoogle Scholar
  12. 12.
    Cloward RB (1953) The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. J Neurosurg 10:154–168 CrossRefGoogle Scholar
  13. 13.
    Harms J, Rolinger H (2008) Die operative Behandlung der Spondylolisthese durch dorsale Aufrichtung und ventrale Verblockung. Z Orthop Ihre Grenzgeb 120:343–347 CrossRefGoogle Scholar
  14. 14.
    Fleege C, Rickert M, Rauschmann M (2015) PLIF- und TLIF-Verfahren. Orthopade 44:114–123 CrossRefGoogle Scholar
  15. 15.
    Gautschi OP, Garbossa D, Tessitore E et al. (2017) Maximal access surgery for posterior lumbar interbody fusion with divergent, cortical bone trajectory pedicle screws: a good option to minimize spine access and maximize the field for nerve decompression. J Neurosurg Sci 61:335–341 Google Scholar
  16. 16.
    Humphreys SC, Hodges SD, Patwardhan AG et al. (2001) Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine (Phila Pa 1976) 26:567–571 CrossRefGoogle Scholar
  17. 17.
    de Kunder SL, van Kuijk SM, Rijkers K et al. (2017) Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J 17:1712–1721 CrossRefGoogle Scholar
  18. 18.
    Cole CD, McCall TD, Schmidt MH, Dailey AT (2009) Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches. Curr Rev Musculoskelet Med 2:118–126 CrossRefGoogle Scholar
  19. 19.
    Tsitsopoulos PP, Serhan H, Voronov LI et al. (2012) Would an anatomically shaped lumbar interbody cage provide better stability? An in vitro cadaveric biomechanical evaluation. J Spinal Disord Tech 25:E240-224 CrossRefGoogle Scholar
  20. 20.
    Uysal M, Ozalay M, Derincek A et al. (2018) Effect of PLIF and TLIF on sagittal spinopelvic balance of patients with degenerative spondylolisthesis. Acta Orthop Traumatol Turc 52:272–276 CrossRefGoogle Scholar
  21. 21.
    Xing D, Ma J-X, Ma X-L et al. (2013) A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J 22(3):605–615 CrossRefGoogle Scholar
  22. 22.
    Dubory A, Giorgi H, Walter A et al. (2015) Surgical-site infection in spinal injury: incidence and risk factors in a prospective cohort of 518 patients. Eur Spine J 24(3):543–554 CrossRefGoogle Scholar
  23. 23.
    Lefrancois T, Mehta K, Sullivan V et al. (2017) Evidence based review of literature on detriments to healing of diabetic foot ulcers. Foot Ankle Surg 23(4):215–224 CrossRefGoogle Scholar
  24. 24.
    Lan T, Hu S-Y, Zhang Y-T et al. (2018) Comparison between posterior lumbar interbody fusion and transforaminal lumbar interbody fusion for the treatment of lumbar degenerative diseases: a systematic review and meta-analysis. World Neurosurg 112:86–93 CrossRefGoogle Scholar
  25. 25.
    Teng I, Han J, Phan K, Mobbs R (2017) A meta-analysis comparing ALIF, PLIF, TLIF and LLIF. J Clin Neurosci 44:11–17 CrossRefGoogle Scholar
  26. 26.
    Johnson RD, Valore A, Villaminar A et al. (2013) Pelvic parameters of sagittal balance in extreme lateral interbody fusion for degenerative lumbar disc disease. J Clin Neurosci 20(4):576–581 CrossRefGoogle Scholar
  27. 27.
    Hood B, Vanni S (2012) Minimally invasive extreme lateral trans-psoas approach to the lumbar spine: applications and techniques. Spine Surgery, InTech. Google Scholar
  28. 28.
    Meredith DS, Kepler CK, Huang RC, Hegde VV (2013) Extreme lateral interbody fusion (XLIF) in the thoracic and thoracolumbar spine: technical report and early outcomes. HSS J 9(1):25–31 CrossRefGoogle Scholar
  29. 29.
    Ozgur BM, Aryan HE, Pimenta L, Taylor WR (2006) Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 6:435–443 CrossRefGoogle Scholar
  30. 30.
    Xu DS, Walker CT, Godzik J et al. (2018) Minimally invasive anterior, lateral, and oblique lumbar interbody fusion: a literature review. Ann Transl Med 6:104 CrossRefGoogle Scholar
  31. 31.
    Putzier M, Hartwig T, Hoff EK et al. (2016) Minimally invasive TLIF leads to increased muscle sparing of the multifidus muscle but not the longissimus muscle compared with conventional PLIF—a prospective randomized clinical trial. Spine J 16(7):811–819 CrossRefGoogle Scholar
  32. 32.
    Khan NR, Clark AJ, Lee SL et al. (2015) Surgical outcomes for minimally invasive vs open transforaminal lumbar interbody fusion: an updated systematic review and meta-analysis. Neurosurgery 77(6):847–874 CrossRefGoogle Scholar
  33. 33.
    Sidhu GS, Henkelman E, Vaccaro AR et al. (2014) Minimally invasive versus open posterior lumbar interbody fusion: a systematic review. Clin Orthop Relat Res 472:1792–1799 CrossRefGoogle Scholar
  34. 34.
    Wu RH, Fraser JF, Härtl R (2010) Minimal access versus open transforaminal lumbar interbody fusion. Spine (Phila Pa 1976) 35:2273–2281 CrossRefGoogle Scholar
  35. 35.
    Ganesan S, Jayabalan V, Kumar V, Kailash K (2018) Clinical and radiological outcomes of modified mini-open and open transforaminal lumbar interbody fusion: a comparative study. Asian Spine J 12:544–550 CrossRefGoogle Scholar
  36. 36.
    Swamy G, Lopatina E, Thomas KC et al. (2019) The cost effectiveness of minimally invasive spine surgery in the treatment of adult degenerative scoliosis: a comparison of transpsoas and open techniques. Spine J 19(2):339–348 CrossRefGoogle Scholar
  37. 37.
    Abbasi H, Grant A (2018) Effect of body mass index on perioperative outcomes in minimally invasive oblique lateral lumbar interbody fusion versus open fusions: a multivariant analysis. Cureus 10:e2288 Google Scholar
  38. 38.
    Lee KH, Yeo W, Soeharno H, Yue WM (2014) Learning curve of a complex surgical technique. J Spinal Disord Tech 27:E234–E240 CrossRefGoogle Scholar
  39. 39.
    Wu A-M, Hu Z-C, Li X-B et al. (2018) Comparison of minimally invasive and open transforaminal lumbar interbody fusion in the treatment of single segmental lumbar spondylolisthesis: minimum two-year follow up. Ann Transl Med 6:105 CrossRefGoogle Scholar
  40. 40.
    Wanderman NR, Francois EL, Nassr A, Sebastian AS (2018) Is minimally invasive transforaminal interbody fusion superior to traditional open technique? Clin Spine Surg 31:139–142 CrossRefGoogle Scholar
  41. 41.
    Arts MP, Wolfs JF, Kuijlen JM, de Ruiter GC (2017) Minimally invasive surgery versus open surgery in the treatment of lumbar spondylolisthesis: study protocol of a multicentre, randomised controlled trial (MISOS trial). BMJ Open 7:e017882 Google Scholar

Copyright information

© Società Italiana Ortopedici Traumatologi Ospedalieri d’Italia 2019

Authors and Affiliations

  • Andrea Piazzolla
    • 1
    Email author
  • Davide Bizzoca
    • 1
  • Viola Montemurro
    • 1
  • Claudia Parato
    • 1
  • Marco La Malfa
    • 1
  • Biagio Moretti
    • 1
  1. 1.Dipartimento Scienze Mediche di Base, Neuroscienze ed Organi di Senso, Clinica Ortopedica, Università degli Studi di Bari “Aldo Moro”AUO Consorziale “Policlinico” di BariBariItalia

Personalised recommendations