Minimally invasive versus open transforaminal lumbar interbody fusion: a prospective, controlled observational study of short-term outcome

Abstract

Instrumented stabilization with intersomatic fusion can be achieved by open (O-TLIF) or minimally invasive (MIS-TLIF) transforaminal surgical access. While less invasive techniques have been associated with reduced postoperative pain and disability, increased manipulation and insufficient decompression may contradict MIS techniques. In order to detect differences between both techniques in the short-term, a prospective, controlled study was conducted. Thirty-eight patients with isthmic or degenerative spondylolisthesis or degenerative disk disease were included in this prospective, controlled study (15 MIS-TLIF group vs. 23 O-TLIF group) after failed conservative treatment. Patients were examined preoperatively, on the first, third, and sixth postoperative day as well as after 2, 4, and 12 weeks postoperatively. Outcome parameters included blood loss, duration of surgery, pre- and postoperative pain (numeric rating scale [NRS], visual analog scale [VAS]), functionality (Timed Up and Go test [TUG]), disability (Oswestry Disability index [ODI]), and quality of life (EQ-5D). Intraoperative blood loss (IBL) as well as postoperative blood loss (PBL) was significantly higher in the O-TLIF group ([IBL O-TLIF 528 ml vs. MIS-TLIF 213 ml, p = 0.001], [PBL O-TLIF 322 ml vs. MIS-TLIF 30 ml, p = 0.004]). The O-TLIF cohort showed significantly less leg pain postoperatively compared to the MIS-TLIF group ([NRS leg 3rd postoperative day, p = 0.027], [VAS leg 12 weeks post-op, p = 0.02]). The MIS group showed a significantly better improvement in the overall ODI (40.8 ± 13 vs. 56.0 ± 16; p = 0.05). After 3 months in the short-term follow-up, the MIS procedure tends to have better results in terms of patient-reported quality of life. MIS-TLIF offers perioperative advantages but may carry the risk of increased nerve root manipulation with consecutive higher radicular pain, which may be related to the learning curve of the procedure.

Latest Developments in Minimally Invasive Spinal Treatment in Slovakia and Its Comparison with an Open Approach for the Treatment of Lumbar Degenerative Diseases

“…Three to twelve months post-operative ODI in MIS-TLIF is significantly lower than in OTLIF. Similar results are reported by 4 different studies [51][52][53][54] who state that, 2 years post-operatively, the ODI scores are significantly lower in the MIS-TLIF group than in the OTLIF group. But no significant differences were found in ODI scores between the two groups at 10 years post-operatively [54].…”

Comparison of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) with bilateral decompression via unilateral approach and open-TLIF with bilateral decompression for degenerative lumbar diseases: a retrospective cohort study

“…This allows decompression or fusion surgery to be performed with minimal tissue damage. At present, there are some comparative studies on MIS-TLIF and Open-TLIF for DLS or DLSS [ 9 – 16 ]. Singh et al found that OT, anesthesia time, Visual Analog Scale scores, EBL and LOS can be significantly reduced through Mis-TLIF compared with Open-TLIF [ 9 ].…”

“…For patients with bilateral lower extremity symptoms or preoperative contralateral foramen stenosis, bilateral decompression was usually recommended to avoid the risk of residual symptoms [ 5 – 7 ]. Minimally Invasive Transforaminal Lumbar Interbody Fusion (Mis-TLIF), which was first descried by Foley et al [ 8 ] as a clinically equivalent and less invasive technique to Open-TLIF, is also widely adopted for the treatment of DLD [ 9 – 16 ]. Additionally, bilateral decompression via unilateral approach (BDUA), which was first descried by Spetzger et al [ 17 , 18 ].…”

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] .…”