The present study, which was based on the authors' initial experience with the minimally invasive approach, could confirm favorable results reported by previous uncontrolled cohort studies in the aspects of less blood loss, less transfusion need, less postoperative back pain, quicker recovery, and shorter hospital stay. It also showed the similar surgical efficacy of the minimally invasive approach with that of the traditional open technique. However, the minimally invasive technique needs longer surgical time and a prudent attention to lower the risk of technical complications. Further long-term, prospective studies involving a larger study group are needed to determine the benefits of this minimally invasive percutaneous procedure.

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BackgroundAs surgical complications tend to occur more frequently in the beginning stages of a surgeon's career, knowledge of perioperative complications is important to perform a safe procedure, especially if the surgeon is a novice. We sought to identify and describe perioperative complications and their management in connection with minimally invasive transforaminal lumbar interbody fusion (TLIF).MethodsWe performed a retrospective chart review of our first 124 patients who underwent minimally invasive TLIF. The primary outcome measure was adverse events during the perioperative period, including neurovascular injury, implant-related complications, and wound infection. Pseudarthroses and adjacent segment pathologies were not included in this review. Adverse events that were not specifically related to spinal surgery and did not affect recovery were also excluded.ResultsPerioperative complications occurred in 9% of patients (11/124); including three cases of temporary postoperative neuralgia, two deep wound infections, two pedicle screw misplacements, two cage migrations, one dural tear, and one grafted bone extrusion. No neurologic deficits were reported. Eight complications occurred in the first one-third of the series and only 3 complications occurred in the last two-thirds of the series. Additional surgeries were performed in 6% of patients (7/124); including four reoperations (two for cage migrations, one for a misplaced screw, and one for an extruded graft bone fragment) and three hardware removals (one for a misplaced screw and two for infected cages).ConclusionsWe found perioperative complications occurred more often in the early period of a surgeon's experience with minimally invasive TLIF. Implant-related complications were common and successfully managed by additional surgeries in this series. We suggest greater caution should be exercised to avoid the potential complications, especially when surgeon is a novice to this procedure.

The results of this study showed that diagonal transfixation provides more rigid fixation in flexion and extension but less in lateral bending and axial rotation in comparison with horizontal transfixation. Furthermore, greater stresses in the pedicle screws were predicted in the diagonal transfixation model. These limitations of diagonal transfixation should be considered carefully for clinical application.