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The aim of this study was to compare our experience with minimally invasive transforaminal lumbar interbody fusion (MITLIF) and open midline transforaminal lumbar interbody fusion (TLIF). A total of 36 patients suffering from isthmic spondylolisthesis or degenerative disc disease were operated with either a MITLIF (n=18) or an open TLIF technique (n=18) with an average follow-up of 22 and 24 months, respectively. Clinical outcome was assessed using the visual analogue scale (VAS) and the Oswestry disability index (ODI). There was no difference in length of surgery between the two groups. The MITLIF group resulted in a significant reduction of blood loss and had a shorter length of hospital stay. No difference was observed in postoperative pain, initial analgesia consumption, VAS or ODI between the groups. Three pseudarthroses were observed in the MITLIF group although this was not statistically significant. A steeper learning effect was observed for the MITLIF group.Résumé Le but de cette étude est de comparer notre expérience de l'arthrodèse lombaire intercorporéale transforaminale par voie mini invasive (MITLIF) ou par voie sanglante classique (TLIF). 36 patients présentant un spondylolisthésis isthmique ou discopathie dégénérative ont été traités soit par MITLIF (n=18) soit par voie sanglante TLIF (n=18), le suivi moyen étant respectivement de 22 et 24 mois. Le devenir clinique a été évalué selon l'échelle visuelle analogique (VAS) et le score d'Oswestry (ODI). Il n'y a pas de différence sur la durée opératoire dans les deux groupes. Le groupe MITLIF a des pertes sanguines et une durée moyenne d'hospitalisation inférieures au groupe TLIF. Il n'y a aucune différence observée sur les douleurs postopératoires, dans la consommation d'analgésiques, le score VAS ou le score ODI. Trois pseudarthroses ont été observées avec la technique MITLIF mais la différence n'est pas significative. Une courbe d'apprentissage plus pentue a été observée avec le groupe MITLIF.

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Insufficiency fractures represent a special category of stress fractures that occur in bones with reduced mineral content and elastic resistance. SIFs, a well-defined subgroup of the latter group, are not uncommon, but lack of clinical suspicion results in many being undiagnosed. SIFs are set to become an important clinical entity of both social and economic significance as the Western population ages. Subtle clinical presentations and signs coupled with radiographic findings that can mimic other unrelated or overlapping conditions, such as sacroiliac joint infection, spinal stenosis and metastatic bone disease, often make SIF diagnosis a challenge. The aim of this review is to increase awareness among clinicians, highlighting SIFs as an important differential diagnosis to be considered when patients present with low back and pelvic pain and subsequently allow prompt management. The paper provides an overview of epidemiology, anatomical considerations, relevant pathophysiology and risk factors, presenting symptoms and signs, investigations and imaging techniques, differential diagnoses and current treatment methods available for the management of SIFs.

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