Background:The aim of the present prospective study is to evaluate whether the touted advantages of minimal invasive-transforaminal lumbar interbody fusion (MI-TLIF) translate into superior, equal, or inferior outcomes as compared to open-transforaminal lumbar interbody fusion (O-TLIF). This is the first study from the Indian subcontinent prospectively comparing the outcomes of MI-TLIF and O-TLIF.Materials and Methods:All consecutive cases of open and MI-TLIF were prospectively followed up. Single-level TLIF procedures for spondylolytic and degenerative conditions (degenerative spondylolisthesis, central disc herniations) operated between January 2011 and January 2013 were included. The pre and postoperative Oswestry Disability Index (ODI) and visual analog scale (VAS) for back pain and leg pain, length of hospital stay, operative time, radiation exposure, quantitative C-reactive protein (QCRP), and blood loss were compared between the two groups. The parameters were statistically analyzed (using IBM® SPSS® Statistics version 17).Results:129 patients underwent TLIF procedure during the study period of which, 71 patients (46 MI-TLIF and 25 O-TLIF) fulfilled the inclusion criteria. Of these, a further 10 patients were excluded on account of insufficient data and/or no followup. The mean followup was 36.5 months (range 18-54 months). The duration of hospital stay (O-TLIF 5.84 days + 2.249, MI-TLIF 4.11 days + 1.8, P < 0.05) was shorter in MI-TLIF cases. There was less blood loss (open 358.8 ml, MI 111.81 ml, P < 0.05) in MI-TLIF cases. The operative time (O-TLIF 2.96 h + 0.57, MI-TLIF 3.40 h + 0.54, P < 0.05) was longer in MI group. On an average, 57.77 fluoroscopic exposures were required in MI-TLIF which was significantly higher than in O-TLIF (8.2). There was no statistically significant difference in the improvement in ODI and VAS scores in MI-TLIF and O-TLIF groups. The change in QCRP values preoperative and postoperative was significantly lower (P < 0.000) in MI-TLIF group than in O-TLIF group, indicating lesser tissue trauma.Conclusion:The results in MI TLIF are comparable with O-TLIF in terms of outcomes. The advantages of MI-TLIF are lesser blood loss, shorter hospital stay, lesser tissue trauma, and early mobilization. The challenges of MI-TLIF lie in the steep learning curve and significant radiation exposure. The ultimate success of TLIF lies in the execution of the procedure, and in this respect the ability to achieve similar results using a minimally invasive technique makes MI-TLIF an attractive alternative.

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Objective: Operating on a wrong level is a nightmare for every surgeon, which has devastating consequences for the patient as well as the surgeon and has potential for serious medical, personal and legal repercussions. There is limited literature of Wrong Level Spine Surgery (WLSS) in Minimally Invasive Spine Surgery (MISS). The aim of the study is to evaluate the incidence of WLSS in MISS using tubular retractors. Methods: The study included a retrospective review of prospectively collected data of all MIS surgeries utilizing tubular retractors during the period extending from January 2007 to December 2014. The surgeries included Micro-Endoscopic Discectomies, Micro-Endoscopic Decompression surgeries for lumbar canal stenosis and Minimal Invasive Trans-Foraminal Lumbar Interbody Fusion (MI-TLIF) surgeries. The surgeries involved docking of the tubular retractor at the level of interest under fluoroscopic guidance. Surgical charts as well as clinical and imaging followup data were analyzed. The incidence of WLSS was analyzed. Results: There were 1,043 surgeries in all in the study period. There were 393 discectomies, 370 decompressions and 280 MI-TLIF surgeries. There were no wrong level surgeries in the entire series. There were two (0.19%) wrong side tube dockings which were subsequently rectified during surgery. No clinical complications were seen. The results were reviewed in light of a meta-analysis of current literature available on WLSS in open and MISS. The results were consistent with the present literature in demonstrating a decreased incidence of WLSS with MISS. Conclusion: The docking of the tubular retractor under fluoroscopic guidance offers an advantage of preventing WLSS. This is an additional benefit of MISS using tubular retractors.

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