Modified Mini-open Transforaminal Lumbar Interbody Fusion

Abstract

Study Design.Retrospective case series.Objective.To describe a modified technique for mini-open transforaminal lumbar interbody fusion (TLIF) that improves visualization for decompression, fusion, and freehand pedicle screw insertion. Accuracy of freehand pedicle screw placement with this technique was assessed.Summary of Background Data.Mini-open TLIF is a minimally invasive technique that allows limited visualization of the bone and neural anatomy via an expandable tubular retractor inserted through the Wiltse plane. No significant modification that of this technique has been described in detail.Methods.In this study, 92 consecutive patients underwent one-level modified mini-open TLIF (MOTLIF). MOTLIF modifications consisted of (i) transmuscular dissection through the multifidus muscle rather than intermuscular dissection in the Wiltse plane; (ii) microsurgical detachment of multifidus from the facet rather than muscle dilation; (iii) en bloc total facetectomy (unilateral or bilateral, as needed for decompression); (iv) facet autograft used for interbody fusion; and (v) solid pedicle screws placed bilaterally by a freehand technique under direct vision.Results.The mean age was 53 years. Mean follow-up was 35 months (minimum 2 yrs). By 6 months, mean Visual Analog Scale for back and leg pain had improved from 51 to 19 and from 58 to 17, respectively, and mean Oswestry Disability Index (ODI) improved from 53 to 16. These improvements persisted at 2 years. Solid fusion, defined by computed tomography at 1 year, was achieved in 88.1%, whereas satisfactory fusion was achieved in 95.2% of patients. Pedicle screws were accurately placed in 335 of 336 imaged pedicles (pedicle breach grades: 91.1% grade 1; 8.6% grade 2; and 0.3% grade 3). Mean fluoroscopy time was 29.3 seconds.Conclusion.MOTLIF is a safe and effective minimally invasive technique with a high fusion rate. It allows accurate pedicle screw placement by a freehand technique. By eliminating bi-planar fluoroscopy, it helps reduce radiation exposure. This is the largest published report of mini-open TLIF to date.Level of Evidence: 4

Accuracy of pedicle screw insertion for unilateral open transforaminal lumbar interbody fusion: a side-by-side comparison of percutaneous and conventional open techniques in the same patients

“…Screw misplacement rates in the range of 8.8-23% have been reported for PPS insertion with C-arm fluoroscopy [5,15,16] while rates of 8.9-31% have been found for conventional open insertion [11,17,18]. Furthermore, the screw misplacement rate when using a navigation system has been reported to be 8-19% with fluoroscopy and 0-11% with CT [11].…”

Application value of expansive pedicle screw in the lumbar short‑segment fixation and fusion for osteoporosis patients

“…The pedicle screw fixation treatment is one of the good methods for the clinical treatment of lumbar compression fractures ( 7 ). However, the stability of conventional pedicle screw fixation for patients with osteoporosis is significantly reduced due to lumbar osteoporosis, and it is difficult to achieve a solid internal fixation effect ( 8 ).…”

Estenose degenerativa do canal lombar

“…A mini-open arthrodesis using the transmuscular posterolateral approach (Wiltse technique), which is less expensive and has the same outcomes as MIS TLIF, is the preference of the authors. 42 43 …”

“…A artrodese por técnica mini-open pelo acesso posterolateral transmuscular (técnica de Wiltse), de menor custo e com os mesmos resultados no comparativo com a técnica MIS TLIF, é a de preferência dos autores. 42 43 …”