Defining the MIS-TLIF: A Systematic Review of Techniques and Technologies Used by Surgeons Worldwide

Abstract

Study Design: Systematic review. Objective: To date there is no consensus among surgeons as to what defines an MIS-TLIF (transforaminal lumbar interbody fusion using minimally invasive spine surgery) compared to an open or mini-open TLIF. This systematic review aimed to examine the MIS-TLIF techniques reported in the recent body of literature to help provide a definition of what constitutes the MIS-TLIF, based on the consensus of the majority of surgeons. Methods: We created a database of articles published about MIS-TLIF between 2010 and 2018. We evaluated the technical components of the MIS-TLIF including instruments and incisions used as well the order in which key steps are performed. Results: We could identify several patterns for MIS-TLIF performance that seemed agreed upon by the majority of MIS surgeons: use of paramedian incisions; use of a tubular retractor to perform a total facetectomy, decompression, and interbody cage implantation; and percutaneous insertion of the pedicle-screw rod constructs with intraoperative imaging. Conclusion: Based on this review of the literature, the key features used by surgeons performing MIS TLIF include the use of nonexpandable or expandable tubular retractors, a paramedian or lateral incision, and the use of a microscope or endoscope for visualization. Approaches using expandable nontubular retractors, those that require extensive subperiosteal dissection from the midline laterally, or specular-based retractors with wide pedicle to pedicle exposure are far less likely to be promoted as an MIS-based approach. A definition is necessary to improve the communication among spine surgeons in research as well as patient education.

Psychological and Functional Comparison between Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion for Single‐Level Lumbar Spinal Stenosis

“…Advantages of the TLIF approach include relatively easier access to the posterior structures, including the lamina, ligamentum flavum, and facet joints 7 . However, Mis-TLIF has demonstrated that it results in less intraoperative blood loss, shorter hospital stay and recovery time, fewer complications, and less need for postoperative narcotic use, with similar clinical outcomes and fusion rates compared with open TLIF [8][9][10][11] . Mis-TLIF remains one of the most popular surgical procedures because of surgeons' familiarity with the posterior approach anatomy 12 .…”

Robot-assisted minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a retrospective matched-control analysis for clinical and quality-of-life outcomes

“…Compared with conventional open TLIF, MIS-TLIF was believed to have several advantages due to its minimally invasive principles such as minimizing soft tissue damage, performing bilateral decompression through unilateral approach and keeping stabilization of the posterior spinal segment [9]. With the advancement of robotic technology, spine surgeons could perform the operation in a more accurate and precise robot-assisted manner [26].…”

“…With the advances in minimally invasive spine surgery, Foley et al introduced minimally invasive TLIF (MIS-TLIF) approach in 2002, which subsequently showed several advantages such as less intraoperative blood loss, shorter recovery time and fewer complications with comparable outcomes [5][6][7][8]. Latest review suggested that 79% of MIS-TLIF publications inserted pedicle screws in a percutaneous approach [9]. Given the indirect visual access of entry point for pedicle screw placement, the risk of screw malposition and perforation may increase in conventional MIS-TLIF procedure [10,11].…”

Overview of Tips in Overcoming Learning Curve in Uniportal and Biportal Endoscopic Spine Surgery

“…It is imperative for the accurate placement of tube to minimize soft tissue damages and decrease operative time. Preoperative plans are made for accurate placement of the tubular retractor 36) . Microscope is used for visualization.…”