Minimally Invasive Direct Thoracic Interbody Fusion (MIS-DTIF): Technical Notes of a Single Surgeon Study

Abstract

BackgroundMinimally invasive direct thoracic interbody fusion (MIS-DTIF) is a new single surgeon procedure for fusion of the thoracic vertebrae below the scapula (T6/7) to the thoracolumbar junction. In this proof of concept study, we describe the surgical technique for MIS-DTIF and report our experience and the perioperative outcomes of the first four patients who underwent this procedure.Study design/settingIn this study we attempt to establish the safety and efficacy of MIS-DTIF. We have performed MIS-DTIF on six spinal levels in four patients with degenerative disk disease or disk herniation. We recorded surgery time, blood loss, fluoroscopy time, complications, and patient-reported pain.MethodsThroughout the MIS-DTIF procedure, the surgeon is aided by biplanar fluoroscopic imaging and electrophysiological monitoring. The surgeon approaches the spine with a series of gentle tissue dilations and inserts a working tube that establishes a direct connection from the outside of the skin to the disk space. Through this working tube, the surgeon performs a discectomy and inserts an interbody graft or cage. The procedure is completed with minimally invasive (MI) posterior pedicle screw fixation.ResultsFor the single level patients the mean blood loss was 90 ml, surgery time 43 minutes, fluoroscopy time 293 seconds, and hospital stay two days. For the two-level surgeries, the mean blood loss was 27 ml, surgery time 61 minutes, fluoroscopy time 321 seconds, and hospital stay three days. We did not encounter any clinically significant complications. Thirty days post-surgery, the patients reported a statistically significant reduction of 5.3 points on a 10-point sliding pain scale.ConclusionsMIS-DTIF with pedicle screw fixation is a safe and clinically effective procedure for fusions of the thoracic spine. The procedure is technically straightforward and overcomes many of the limitations of the current minimally invasive (MI) approaches to the thoracic spine. MIS-DTIF has the potential to improve patient outcomes and reduce costs relative to the current standard of care. We are currently expanding this study to a larger cohort and recording long term outcomes and costs.

Efficacy and Clinical Outcomes of Minimally Invasive Direct Thoracic Interbody Fusion: A Retrospective Analysis

“…Even in the hands of experienced surgeons, invasive open procedures risk higher rates of perioperative complications for the patient, which include neurologic injuries in addition to pulmonary complications such as hemothorax and lung contusions. Due to the necessity for risk reduction in surgical thoracic spine patients, a minimally invasive spine procedure -MIS-DTIF -was developed by the first author [14]. In this technique, there is no open exposure or direct visualization of the posterior or lateral spine structures, which is complemented by MIS pedicle screw fixation that minimizes risk of lung injury encountered in traditional open approaches [4,5].…”

“…This is usually associated with increased pain, lengthy hospital stays, and higher morbidity/mortality, which has been reported to be up to 30%. Despite these numerous technical complications, there is no proven benefit of one approach over the other, nor is there high-quality evidence to report quality improvement in symptom control using a specific approach [9][10][11][12][13][14].…”

“…Minimally invasive direct thoracic interbody fusion (MIS-DTIF) is a recently described novel approach that aims to minimize the pain and disability associated with thoracic disc herniation or stenosis while providing effective and long-lasting pain relief [14][15][16][17][18][19]. We, therefore, aimed to evaluate the perioperative clinical outcomes, as well as pain and disability outcomes in spine patients diagnosed with degenerative thoracic disc herniation or thoracic stenosis that was surgically managed by the MIS-DTIF procedure.…”

Physiologic Decompression of Lumbar Spinal Stenosis Through Anatomic Restoration Using Trans-Kambin Oblique Lateral Posterior Lumbar Interbody Fusion (OLLIF): A Retrospective Analysis

“…Physiologic decompression has several advantages over direct decompression because it can be performed in an MIS manner. Although several MIS options exist, OLLIF has several advantages over other procedures because it can be performed from T12-S1, and, with some modification, can be performed in the thoracic spine below T6 and requires less surgery time than other MIS fusions [ 18 ].…”

Effect of Body Mass Index on Perioperative Outcomes in Minimally Invasive Oblique Lateral Lumbar Interbody Fusion versus Open Fusions: A Multivariant Analysis

“…In OLLIF, the disc is approached through Kambin’s triangle using bilateral fluoroscopic imaging and electrophysiology to guide the approach. Variations of OLLIF enable a surgeon to approach technically difficult areas such as L5-S1 [ 12 ] and the thoracic region [ 13 ].…”