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. 2016 Sep;50(5):464-472.
doi: 10.4103/0019-5413.189607.

Minimal invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion

Arvind G Kulkarni  1 , Hussain Bohra  1 , Abhilash Dhruv  1 , Abhishek Sarraf  1 , Anupreet Bassi  1 , Vishwanath M Patil  1
Affiliations

Minimal invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion

Arvind G Kulkarni et al. Indian J Orthop. 2016 Sep.

Abstract

Background: The aim of the present prospective study is to evaluate whether the touted advantages of minimal invasive-transforaminal lumbar interbody fusion (MI-TLIF) translate into superior, equal, or inferior outcomes as compared to open-transforaminal lumbar interbody fusion (O-TLIF). This is the first study from the Indian subcontinent prospectively comparing the outcomes of MI-TLIF and O-TLIF.

Materials and methods: All consecutive cases of open and MI-TLIF were prospectively followed up. Single-level TLIF procedures for spondylolytic and degenerative conditions (degenerative spondylolisthesis, central disc herniations) operated between January 2011 and January 2013 were included. The pre and postoperative Oswestry Disability Index (ODI) and visual analog scale (VAS) for back pain and leg pain, length of hospital stay, operative time, radiation exposure, quantitative C-reactive protein (QCRP), and blood loss were compared between the two groups. The parameters were statistically analyzed (using IBM® SPSS® Statistics version 17).

Results: 129 patients underwent TLIF procedure during the study period of which, 71 patients (46 MI-TLIF and 25 O-TLIF) fulfilled the inclusion criteria. Of these, a further 10 patients were excluded on account of insufficient data and/or no followup. The mean followup was 36.5 months (range 18-54 months). The duration of hospital stay (O-TLIF 5.84 days + 2.249, MI-TLIF 4.11 days + 1.8, P < 0.05) was shorter in MI-TLIF cases. There was less blood loss (open 358.8 ml, MI 111.81 ml, P < 0.05) in MI-TLIF cases. The operative time (O-TLIF 2.96 h + 0.57, MI-TLIF 3.40 h + 0.54, P < 0.05) was longer in MI group. On an average, 57.77 fluoroscopic exposures were required in MI-TLIF which was significantly higher than in O-TLIF (8.2). There was no statistically significant difference in the improvement in ODI and VAS scores in MI-TLIF and O-TLIF groups. The change in QCRP values preoperative and postoperative was significantly lower (P < 0.000) in MI-TLIF group than in O-TLIF group, indicating lesser tissue trauma.

Conclusion: The results in MI TLIF are comparable with O-TLIF in terms of outcomes. The advantages of MI-TLIF are lesser blood loss, shorter hospital stay, lesser tissue trauma, and early mobilization. The challenges of MI-TLIF lie in the steep learning curve and significant radiation exposure. The ultimate success of TLIF lies in the execution of the procedure, and in this respect the ability to achieve similar results using a minimally invasive technique makes MI-TLIF an attractive alternative.

Keywords: MI-TLIF; Spinal column; TLIF; arthrodesis; bone screws; lumbar vertebrae; minimally invasive spine surgery; minimally invasive surgical procedure; percutaneous pedicle screw; spinal fusion.

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Figures

Figure 1
Figure 1
Bar chart depicting the distribution of patients with regards to diagnosis in minimal invasive-transforaminal lumbar interbody fusion, as well as open-transforaminal lumbar interbody fusion
Figure 2
Figure 2
Clinical case demonstration: Minimal invasive-transforaminal lumbar interbody fusion in spondylolytic spondylolisthesis. (a) Preoperative radiograph lumbosacral spine and T2W sagittal MRI showing spondylolisthesis L4L5 vertebral body (b) Intra operative photograph showing decompression tubular retractor. (c) Intraoperative photograph showing manipulation (d) Postoperative radiograph showing implant and cage in situ (e) Postoperative photograph showing scar mark
Figure 3
Figure 3
Clinical case demonstration: Minimal invasive-transforaminal lumbar interbody fusion in degenerative stenosis with scoliosis. (a) Preoperative anteroposterior and lateral radiograph; T2W axial and sagittal MRI of LS spine showing degenerative sterosis with scoliosis (b) Intraoperative photograph showing decompression (c) Postoperative photograph showing pedicle screws and cage in situ (d) Postoperative photograph showing scar mark
Figure 4
Figure 4
Clinical photograph showing postoperative scar in minimal invasive-transforaminal lumbar interbody fusion patient with good cosmesis
Figure 5
Figure 5
Bar chart showing the demographic data of minimal invasive-transforaminal lumbar interbody fusion and open-transforaminal lumbar interbody fusion
Figure 6
Figure 6
Bar chart showing the percentage change in Oswestry Disability Index score in minimal invasive-transforaminal lumbar interbody fusion and open-transforaminal lumbar interbody fusion
Figure 7
Figure 7
Bar chart showing the percentage change in visual analog scale score-leg pain in minimal invasive-transforaminal lumbar interbody fusion and open-transforaminal lumbar interbody fusion
Figure 8
Figure 8
Bar chart showing the percentage change in visual analog scale score-back pain in minimal invasive-transforaminal lumbar interbody fusion and open-transforaminal lumbar interbody fusion
Figure 9
Figure 9
Bar chart showing the average quantitative C-reactive protein levels in minimal invasive-transforaminal lumbar interbody fusion and open-transforaminal lumbar interbody fusion
Figure 10
Figure 10
Bar chart showing the average hospital stay in minimal invasive-transforaminal lumbar interbody fusion and open-transforaminal lumbar interbody fusion groups
Figure 11
Figure 11
Bar chart showing the average blood loss in minimal invasive-transforaminal lumbar interbody fusion and open-transforaminal lumbar interbody fusion groups
Figure 12
Figure 12
Bar chart showing the average operative time in minimal invasive-transforaminal lumbar interbody fusion and open-transforaminal lumbar interbody fusion
Figure 13
Figure 13
Bar chart showing the average fluoroscopic shoots in minimal invasive-transforaminal lumbar interbody fusion and open-transforaminal lumbar interbody fusion
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