Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2

Abstract

Minimally invasive lumbar fusion techniques have only recently been developed. The goals of these procedures are to reduce approach-related soft tissue injury, postoperative pain and disability while allowing the surgery to be conducted in an effective manner. There have been no prospective clinical reports published on the comparison of one-level transforaminal lumbar interbody fusion in low-grade spondylolisthesis performed with an independent blade retractor system or a traditional open approach. A prospective clinical study of 85 consecutive cases of degenerative and isthmic lower grade spondylolisthesis treated by minimally invasive transforaminal lumbar interbody fusion (MiTLIF) or open transforaminal lumbar interbody fusion (OTLIF) was done. A total of 85 patients suffering from degenerative spondylolisthesis (n = 46) and isthmic spondylolisthesis (n = 39) underwent one-level MiTLIF (n = 42) and OTLIF (n = 43) by two experienced surgeons at one hospital, from June 2006 to March 2008 (minimum 13-month follow-up). The following data were compared between the two groups: the clinical and radiographic results, operative time, blood loss, transfusion needs, X-ray exposure time, postoperative back pain, length of hospital stay, and complications. Clinical outcome was assessed using the visual analog scale (VAS) and the Oswestry disability index. The operative time, clinical and radiographic results were basically identical in both groups. Comparing with the OTLIF group, the MiT-LIF group had significantly lesser blood loss, lesser need for transfusion, lesser postoperative back pain, and shorter length of hospital stay. The radiation time was significantly longer in MiTLIF group. One case of nonunion was observed from each group. Minimally invasive TLIF has similar surgical efficacy with the traditional open TLIF in treating one-level lower grade degenerative or isthmic spondylolisthesis. The minimally invasive technique offers several potential advantages including smaller incisions, less tissue trauma and quicker recovery. However, this technique needs longer X-ray exposure time.

Minimally invasive versus open transforaminal lumbar interbody fusion: a meta-analysis based on the current evidence

“…Some surgeons have suggested that MI-TLIF could increase surgical time [6,7]. Secondly, to facilitate a minimally invasive approach, more X-ray exposure was used [4,[7][8][9]. Thirdly, MI-TLIF has a steep learning curve and is a technically demanding procedure.…”

“…However, only limited Class I evidence is available [4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The objective of the present study was to provide cumulative effect estimates of the clinical and radiological outcomes using meta-analysis and to determine which surgical technique was more beneficial.…”

The effect of obesity on patient-reported outcome measures after minimally invasive transforaminal lumbar interbody fusion

“…An MIS approach to the lumbar spine decreases iatrogenic soft tissue injury and theoretically improves dynamic muscular stabilization at an index level [17,[37][38][39][40][41]. MIS techniques also pose several potential advantages for use in obese patients in terms of decreased incision length, blood loss, operative time, hospital stay and post-operative pain where abundant subcutaneous adipose tissue may necessitate a larger incision and dissection for adequate exposure when utilizing a traditional open approach.…”

Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis

“…Several studies have reported the favorable outcomes of MIS-TLIF accompanied by spinal instrumentation with percutaneous pedicle screw insertion and decompression in degenerative spondylolisthesis [1,3,5,12,20,21,23,25]. In the presence of severe spinal canal stenosis and distorted facet anatomy due to severe FJO, MIS techniques however could limit direct visualization of neural elements and pedicle screws relative to key anatomical structures and could increase the rate of complications and pedicle screw misplacement.…”