Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis

Phan, Kevin; Rao, Prashanth J.; Kam, Antony; Mobbs, Ralph J.

doi:10.1007/s00586-015-3903-4

Cited by 163 publications

(126 citation statements)

References 45 publications

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“…6,7 The minimally invasive TLIF procedure has been recently shown to reduce morbidity and health care costs in comparison with open TLIF. 5,8,10,11,14 We set out to evaluate the relevant anatomy at the neural foramen in consideration for the development of an interbody fusion device, appropriate instruments for neural decompression, and OBjEcTIVE The authors describe a cadaveric analysis to determine the ideal dimensions and trajectory for considering endoscopic transforaminal interbody implantation. mEThOdS The soft tissues of 8 human cadavers were removed from L-1 to the sacrum, exposing the posterior bony elements.…”

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confidence: 99%

The anatomic rationale for transforaminal endoscopic interbody fusion: a cadaveric analysis

Hardenbrook

Lombardo²,

Wilson³

et al. 2016

FOC

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OBJECTIVE The authors describe a cadaveric analysis to determine the ideal dimensions and trajectory for considering endoscopic transforaminal interbody implantation. METHODS The soft tissues of 8 human cadavers were removed from L-1 to the sacrum, exposing the posterior bony elements. Facetectomies were performed bilaterally at each lumbar level with resection of the pars interarticularis, revealing the pedicles, nerve roots, and interbody disc space. Each level was digitally photographed with a marker for scale and evaluated with digital analysis software. The traversing and exiting nerve roots and pedicle margins were identified, and the distances between these structures and their relationships to the surrounding structures were documented. RESULTS The dimensions of 2 areas were measured: the working triangle and safe zone. The working triangle is the triangle between the exiting and traversing nerve roots above the superior margin of the inferior pedicle. The safe zone is the trapezoid bounded by the widths of the superior and inferior pedicles between the exiting and traversing nerve roots. The mean surface area for the working triangle was 1.83 cm2, with L5–S1 having the largest area at 2.19 cm2. The mean surface area of the safe zone was 1.19 cm2, with L5–S1 having the largest area at 1.26 cm2. At the medial border of the pedicle extending superiorly, there were no nerve structures within 1.19 cm at any level. On the lateral border of the pedicle, the exiting nerve root was closer superiorly, with the closest being 0.3 cm. CONCLUSIONS The working triangle is a relatively large area. The safe zone, just superior to the pedicle, is free of nerve structures. By utilizing the superior border of the pedicle, the disc space can be accessed within this safe zone without risk of injury to the nerves. A thorough understanding of foraminal anatomy is fundamental for considering how to safely access the disc space, thereby utilizing less invasive endoscopic techniques, and is an important first step in considering what shapes and sizes of interbody implants and retractors are feasible for use in the foramen.

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mentioning

confidence: 99%

The anatomic rationale for transforaminal endoscopic interbody fusion: a cadaveric analysis

Hardenbrook

Lombardo²,

Wilson³

et al. 2016

FOC

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“…10 Surgical time: In some cohort studies times are reported without a significant difference, such as 185 minutes in MIS TLIF versus 186 minutes in OPEN TLIF, and 166.4 minutes in MIS TLIF versus 181.1 in OPEN TLIF. 1,2 However, in other studies there are marked differences between the surgical times, such as 216. 4 5,9,11 Several studies reported inverted results with 161 minutes for MIS TLIF versus 227.4 minutes for OPEN TLIF, however, because of the heterogeneity detected, the difference was not significant.…”

Section: Introductionmentioning

confidence: 96%

“…1 Lumbar fusion is used to manage spinal deformity and instability, with the objective of achieving segmental arthrodesis with adequate disc height, vertebral alignment, and decompression of the neurological structures. 2 Transforaminal Lumbar Interbody Fusion (TLIF) is one of the surgical options used for the stabilization and treatment of degenerative lumbar diseases such as degenerative discopathy and spondylolisthesis that do not respond to conservative management. 1 Since Harms and Rolinger first described the procedure in 1982, OPEN TLIF has allowed circumferential arthrodesis and restoration of disc height, with a fusion rate of 95%, and has been considered a safe and effective option for the past 30 years.…”

Section: Introductionmentioning

confidence: 99%

“…12 Hospital stay: In most studies, the duration of the hospital stay for patients who underwent MIS TLIF was significantly shorter than OPEN TLIF, 4.7 days for MIS TLIF versus 8 days for OPEN TIF, as well as a difference of 1 day between MIS TLIF and OPEN TLIF, 3 days for MIS TLIF versus 5 days for OPEN TLIF, 6.1 days versus 8.2 days for MIS TLIF versus OPEN TLIF, respectively, and 3.2 days for MIS TLIF versus 6.8 days for OPEN TLIF. 1,2,8,9 A total of 18 studies reported a significant difference with a decrease of 1.3 days between MIS TLIF and OPEN TLIF. 13 Exposure to radiation: Most studies report higher exposure to radiation in MIS TLIF, ranging from 45.3 to 106 seconds as compared to 24-39 seconds for OPEN TLIF.…”

Section: Introductionmentioning

confidence: 99%

“…12 One study reported a more serious complication in the open technique (myocardial infarction) and in MIS TLIF (poor screw placement requiring revision surgery) and two lesser complications for each (OPEN: pneumonia and postoperative anemia; MIS: pneumonia and incidental durotomy). 2 A total of 25 studies extracted sufficient data, with the total number of complications resulting in a relative risk of 0.65% when comparing MIS TLIF versus OPEN TLIF with a confidence interval of 95% from 0.50 to 0.83 (P<0.001). 10 Eight studies reported a higher reintervention rate in cases of MIS TLIF, but it is not statistically significant, associating greater failure in graft placement and fusion with MIS TLIF and a higher rate of incidental durotomy and infection of the surgical wound in OPEN TLIF.…”

Section: Introductionmentioning

confidence: 99%

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Tlif-Mis vs Tlif-Open: Cost Evaluation

et al. 2018

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Objective: To evaluate the direct costs of transforaminal lumbar interbody fusion (TLIF) and minimally invasive surgery (MIS) or open technique (OPEN). Methods: The present study is descriptive and retrospective. Sixteen patients with degenerative spinal pathology operated on with the TLIF MIS technique and TLIF OPEN were included over a 13-month period. Days of hospital stay, blood loss, surgical time, medical care and costs were compared. Results: The mean number of days of hospital stay was 6.7 ± 4.3 days with TLIF MIS and 11.1 ± 6.5 days with TLIF OPEN. The blood loss was 307 ± 81.6 ml (range 200-400 ml) with TLIF MIS and 803 ± 701.3 ml (range 200-1800 ml) with TLIF OPEN. The surgical time was 320 ± 92.6 minutes (range 210-500 minutes) in TLIF MIS and 372 ± 95.2 minutes (280-540 minutes) in TLIF OPEN. Conclusions: The difference in surgical costs and time between the two procedures was not statistically significant. There was less bleeding during the TLIF-MIS surgery, as well as a correlation between shorter days of hospital stay proportional to bleeding and surgical time, which translates into a reduction in the cost of these items. Level of Evidence III; Analysis based on alternatives and limited costs.Keywords: Intervertebral disc degeneration; Spinal fusion; Arthrodesis. de 6,7 ± 4,3 días con TLIF MIS y de 11,1 ± 6,5 días con TLIF OPEN. La pérdida sanguínea fue de 307 ± 81, con TLIF MIS y de 803 ± 701,3 ml (rango 200-1800 ml) RESUMO Objetivo: Garantir benefícios econômicos diretos de cada procedimento cirúrgico. Metodologia: apresentar um estudo descritivo e retrospectivo. Dezesseis pacientes com patologia degenerativa de colônias operados com a técnica TLIF MIS e TLIF OPEN foram incluídos durante um período de 13 meses. Foram comparados os dias de internação RESUMEN Objetivo: Evaluar los costos directos de la fusión intersomática lumbar transforaminal (TLIF) de mínima invasión (MIS) o técnica abierta (OPEN). Métodos: El presente estudio es descriptivo y retrospectivo. Se incluyeron 16 pacientes con patología degenerativa de columna intervenidos con la técnica TLIF MIS y TLIF OPEN en un período de 13 meses. Se compararon días de estancia hospitalaria, pérdida sanguínea, tiempo quirúrgico, atención médica y costos. Resultados: La media de días de estancia hospitalaria fue

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Minimally Invasive Spine Surgery Complications with Implant Placement and Fixation

Butler

Kurd

2019

Minimally Invasive Spine Surgery

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Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis

Cited by 163 publications

References 45 publications

The anatomic rationale for transforaminal endoscopic interbody fusion: a cadaveric analysis

The anatomic rationale for transforaminal endoscopic interbody fusion: a cadaveric analysis

Tlif-Mis vs Tlif-Open: Cost Evaluation

Minimally Invasive Spine Surgery Complications with Implant Placement and Fixation

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