Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Treatment of Degenerative Lumbar Diseases

Abstract

Minimally invasive TLIF as a management of 1-level degenerative lumbar diseases is superior to the traditional open procedure in terms of postoperative back pain, total blood loss, need for transfusion, time to ambulation, length of hospital stay, soft-tissue injury, and functional recovery. However, this procedure takes longer operative duration and requires close attention to the risk of technical complications. Longer-term studies involving a larger sample are needed to validate the long-term efficacy of minimally TLIF.

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

“…The advantages associated with MI-TLIF might be attributed to less intraoperative dissection and retraction of paravertebral muscles [1,2,5]. Shunwu et al [6] found the minimally invasive group was associated with a significantly lower creatine kinase (a marker of muscle injury) level on the third postoperative day. Wang et al [7] observed no differences in postoperative serum creatine kinase levels between the MI and open groups.…”

“…First, with limited visibility and working space, MI-TLIF requires good familiarity of anatomy. 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].…”

“…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.…”

Percutaneous instrumentation of the cervical and cervico-thoracic spine using pedicle screws: preliminary clinical results and analysis of accuracy

“…As proposed already in lumbar spine surgery, this might reduce the denervation of muscles and hospital stay [10,16,21,22,38,44] and reduces the increased complication rate following posterior or combined anterior-posterior approaches [37]. The disadvantage of the technique clearly resulted from stabilization-only character, which limits the indications.…”

“…In this context, multi-level posterior as well as combined anteriorposterior approaches to the cervical spine are proposed to be associated with increased incidence of perioperative complications [37]. Similar to stabilization procedures of the thoracolumbar spine with the objective to reduce access-related morbidity as muscular denervation and atrophy, length of hospital stay and blood loss [10,16,21,22,38,44], minimally invasive procedures for cervical instrumentation represent the next step to reduce accessrelated muscular trauma. Therefore, several authors reported minimally invasive posterior procedures for stabilization and decompression of the cervical spine [8,33,40,45].…”