Minimally Invasive Transforaminal Lumbar Interbody Fusion with Unilateral Pedicle Screw Fixation: Comparison between Primary and Revision Surgery

Abstract

Minimally invasive surgery with a transforaminal lumbar interbody fusion (MIS TLIF) is an important minimally invasive fusion technique for the lumbar spine. Lumbar spine reoperation is challenging and is thought to have greater complication risks. The purpose of this study was to compare MIS TLIF with unilateral screw fixation perioperative results between primary and revision surgeries. This was a prospective study that included 46 patients who underwent MIS TLIF with unilateral pedicle screw. The patients were divided into two groups, primary and revision MIS TLIF, to compare perioperative results and complications. The two groups were similar in age, sex, and level of operation, and were not significantly different in the length of follow-up or clinical results. Although dural tears were more common with the revision group (primary 1; revision 4), operation time, blood loss, total perioperative complication, and fusion rates were not significantly different between the two groups. Both groups showed substantial improvements in VAS and ODI scores one year after surgical treatment. Revision MIS TLIF performed by an experienced surgeon does not necessarily increase the risk of perioperative complication compared with primary surgery. MIS TLIF with unilateral pedicle screw fixation is a valuable option for revision lumbar surgery.

Complication Risk in Primary and Revision Minimally Invasive Lumbar Interbody Fusion: A Comparable Alternative to Conventional Open Techniques?

“…However, higher rates of incidental durotomy were reported in revision cases compared with primary cases for both TLIF and PLIF approaches. Kang et al 17 Limitations to this study include the retrospective nature of our data collection, which predisposes to selection bias. Additionally, the small sample size of MIS patients limits the statistical power of our findings, as some results may reflect spurious statistical noise.…”

“…However, higher rates of incidental durotomy were reported in revision cases compared with primary cases for both TLIF and PLIF approaches. Kang et al 17 also investigated perioperative outcomes in MIS TLIF patients undergoing primary surgery or revision. No differences were reported in EBL (94.4 vs 87.5 mL, P > .05), operative time (88.8 vs 88.4 minutes, P > .05), or intraoperative complication rates ( P = .16).…”

“…Nonetheless, complications associated with revision surgery (including interbody fusions) have been well-documented in the literature. 8,17,21 Previous open spine surgery predisposes patients to a greater risk of perioperative complications and poorer clinical outcomes due to extensive scar tissue exploration and distortion of anatomical landmarks. 21 Fewer studies, however, have explored the utility of minimally invasive techniques for revisions.…”

“…MIS interbody fusion has been reported as a safe and effective alternative to conventional open fusion, both as a primary and revision procedure. [17][18][19][20] However, limited data exists which directly compares outcomes of MIS and open lumbar interbody fusions in terms of primary and revision index. This study aims to compare perioperative complications of patients undergoing primary and revision interbody fusions across both open and MIS techniques.…”

Comparative Finite Element Analysis of Lumbar Cortical Screws and Pedicle Screws in Transforaminal and Posterior Lumbar Interbody Fusion

“…It has been proposed that the preservation of posterior muscle structures is important for the prevention of postoperative back pain and the success of lumbar stabilization [24]. Therefore, minimally invasive techniques have been introduced to preserve the posterior paravertebral muscles, including the multifidus [27-29]. Because the starting point of lumbar CSF is located more medially than that of PSF, this technique can avoid extensive muscle dissection and retraction [1].…”