Does Conventional Open TLIF cause more Muscle Injury when Compared to Minimally Invasive TLIF?—A Prospective Single Center Analysis

Abstract

Study design Prospective, observational. Objectives The aim of our study was to assess the amount of reduction in lean muscle mass (LMM) of multifidus muscle (MFM) between conventional open Transforaminal lumbar interbody fusion (CO-TLIF) as compared to Minimally invasive spine Transforaminal lumbar interbody fusion (MIS-TLIF). Methods This study was conducted between 2017 and 2020. It included 100 patients divided into two groups, 50 patients treated with CO-TLIF, 50 treated with MIS-TLIF. Only patients undergoing single level, primary lumbar fusion at L4-5 or L5-S1 level for degenerative pathologies were included. All patients were assessed by magnetic resonance imaging (MRI) scans 1-year post surgery. Measurements were performed using ImageJ image processing program. Results Mean percentage reduction in LMM in CO-TLIF group was 45.52 ± 12.36% and MIS-TLIF group was 25.83 ± 9.64% [statistically significant (t = 8.78, P < .001)]. Mean percentage reduction in LMM on side of cage insertion was 39.63 ± 15.96% and opposite side was 31.40 ± 15.01% [statistically significant (t = 9.06, P < .001)]. Mean reduction of LMM among males was 29.38 ± 15.23% and females was 40.42 ± 12.67% [statistically significant (t = −3.95, P < .001)]. We observed significant but weak degree of correlation between age and percentage reduction of LMM (r = .22, P = .028). Conclusion Mean reduction in LMM was greater in CO-TLIF group as compared to MIS-TLIF. There was greater reduction in LMM in females and on side of cage insertion. We also found greater reduction in LMM with increasing age in both groups.

Surgical Strategy for Lumbar Disc Herniation based on the MSU Classification: Percutaneous Endoscopic Lumbar Discectomy versus Transforaminal Lumbar Interbody Fusion: A 5‐year Retrospective Study

“…This could also explain why many patients with LDH are now less inclined to undergo TLIF. Although traditional open TLIF surgery is associated with a more extended recovery period and tremendous postoperative pain, appropriate postoperative management and rehabilitation programs can effectively address these issues and accelerate the patient's return to normal daily activities 27,28 . Therefore, based on the above clinical evaluation, PELD has advantages over TLIF in MSU classifications 3B, 2B, and 2C.…”

Evolution of the Transforaminal Lumbar Interbody Fusion (TLIF): From Open to Percutaneous to Patient-Specific

“…However, it was still plagued by paraspinal iatrogenic injury, due to the extensive period of muscle retraction, which often results in long recovery periods, albeit to a lesser degree than the PLIF [11,12]. In fact, many previous studies comparing the well described, long-term postoperative paraspinal muscle degeneration associated with the traditional open TLIF found that its minimally invasive counterpart demonstrated clear superiority in this avenue (Figure 1) [13][14][15][16].…”

Is minimally invasive superior to traditional open technique for two-segmental transforaminal interbody fusion in the treatment of lumbar degenerative disease?

“…Minimally invasive surgery (MIS) TLIF has gained widespread popularity in recent years, because of less soft tissue injury than traditional open TLIF technique [3] . Meanwhile, many literatures have reported that MIS-TLIF have the advantages of less intraoperative blood loss, shorter hospitalization, less postoperative low back pain and lower rate of reoperation compared with open TLIF [3,4,5] . However, some disadvantages have been described with the use of MIS-TLIF technique such as longer operation time, more radiation exposure and a long learning curve [5,6] .…”