Minimally invasive versus open transforaminal lumbar fusion: a systematic review of complications

Abstract

Purpose The aim of this study is to compare mTLIF vs. oTLIF with regard to peri-operative complications, operative time, estimated blood loss, fluoroscopic time, and the length of hospital stay. Methods The PubMed and EMBASE databases were searched for relevant articles reporting patients undergoing TLIF, and a comparison between mTILF and oTLIF was performed. The database included patient demographic information, complications, operative time, fluoroscopic time, and the length of hospital stay. Results Fourteen studies were included in this systematic review. The total number of subjects included was 901, of which 455 underwent mTLIF (50 %) and 446 underwent oTLIF (50 %). The operating time for the mTLIF was ranged from 116 to 390 minutes, compared with 102 to 365 minutes for oTLIF, the operating time tended to be longer in the mTLIF group than the oTLIF group. The estimated blood loss was lower in the mTLIF group, ranging from 51 to 578 ml in mTLIF and 225 to 961 ml in oTLIF, respectively. Length of hospital stay was short for the mTLIF with a 2.3 to 10.6 days hospitalization compared to 2.9 to 14.6 days for oTLIF. However the fluoroscopic time was consistently higher in the mTLIF group with a 49 to 106 seconds of fluoroscopy compared to 16.4 to 44 seconds for oTLIF. The complications divided into technical complications and infection complications. The main technical and infection complications included dural tears, screw malposition, and wound infection. Systemic complications included pneumonia, urinary tract infection, and DVT. The numbers of patients with complication was 54 out of 455 (11.87 %) in the mTLIF, and 64 out of 446 (14.35 %) in the oTLIF. Conclusion The review shows mTLIF offers several potential advantages in reducing blood loss and the length of hospital stay, especially lowering the complication rates for patients compared with oTLIF. However, it required much more operative time and radiation exposure. Class I evidence and highquality randomized controlled trials are needed for further study. Keywords Complications . Minimally invasive spine surgery . Transforaminal lumbar interbody fusionTransforaminal lumbar interboby fusion (TLIF) has been widely performed for degenerative lumbar disease since Harms [1] popularized the procedure. It provides circumferential spinal fusion, restores disc height, and maintains the normal lordosis of the lumbar spine. Due to these advantages and good fusion rates in 95 % [2-6], TLIF has been proven as a safe and effective technique in the past three decades. However, extensive paravertebral muscle stripping and retraction during the procedure to obtain an adequate surgical field causes significant soft tissue injury. This iatrogenic

Management of burst fractures in the thoracolumbar spine

“…58,60 Compared with open procedures, minimally invasive spine surgery allows to be addressed through smaller incisions with less soft-tissue damage and postoperative pain, which may lead to shorter hospitalizations and earlier mobility for the patient. 61 MISS techniques may be an excellent solution in the politrauma patients, providing ''damage-control spinal stabilization.'' 62 …”

Tlif-Mis vs Tlif-Open: Cost Evaluation

“…3 Costs: The direct hospital costs for each study were lower in MIS TLIF than in OPEN TLIF, associated with less blood loss, fewer days in the hospital, and fewer complications. 12 A financial analysis of the total direct hospital costs (blood, imaging, implant, drugs, physical/occupational or speech therapy, hospital stay) were lower in MIS TLIF than in OPEN TLIF, at USD 19,512 versus USD 23,550, respectively. The cost of the implants was similar.…”

“…4 5,9,11 Several studies reported inverted results with 161 minutes for MIS TLIF versus 227.4 minutes for OPEN TLIF, however, because of the heterogeneity detected, the difference was not significant. 12 Hospital stay: In most studies, the duration of the hospital stay for patients who underwent MIS TLIF was significantly shorter than OPEN TLIF, 4.7 days for MIS TLIF versus 8 days for OPEN TIF, as well as a difference of 1 day between MIS TLIF and OPEN TLIF, 3 days for MIS TLIF versus 5 days for OPEN TLIF, 6.1 days versus 8.2 days for MIS TLIF versus OPEN TLIF, respectively, and 3.2 days for MIS TLIF versus 6.8 days for OPEN TLIF. 1,2,8,9 A total of 18 studies reported a significant difference with a decrease of 1.3 days between MIS TLIF and OPEN TLIF.…”

“…1,11 Complication rates of 8.1% in MIS TLIF versus 16.2% in the open technique have been reported, evaluating the incidence of infection of the wounds, poor implant position, leakage of cerebrospinal fluid, urinary tract infection, and mild neurological deficit. 12 One study reported a more serious complication in the open technique (myocardial infarction) and in MIS TLIF (poor screw placement requiring revision surgery) and two lesser complications for each (OPEN: pneumonia and postoperative anemia; MIS: pneumonia and incidental durotomy). 2 A total of 25 studies extracted sufficient data, with the total number of complications resulting in a relative risk of 0.65% when comparing MIS TLIF versus OPEN TLIF with a confidence interval of 95% from 0.50 to 0.83 (P<0.001).…”

“…However, there is a tendency towards longer surgical time and greater exposure to radiation. 5,12,[15][16][17][18][19] …”