Abstract
Background Comparison of single-level open and minimally invasive transforaminal lumbar interbody fusions (O-TLIF and MI-TLIF) of a single surgeon and presentation of his MI-TLIF learning curve in a retrospective observational cohort study. Methods 27 MI-TLIF and 31 O-TLIF patients, performed between 03/01/2013 and 03/31/2018, were compared regarding the operative time, blood loss, blood transfusion frequency, postoperative length of stay (LOS), and adverse events. An overall comparison of pre- and postoperative Oswestry Disability Index (ODI) results and Visual Analog Score (VAS) results of low back and leg pain was performed in the case of the two techniques. For a learning curve presentation, the MI-TLIF cases were compared and the optimal operative time was determined. Results The gender ratio and age did not differ in the groups. Operative time showed no difference (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (p=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (Conclusions Similar operative time and postoperative quality of life improvement can be achieved by MI-TLIF procedure as with O-TLIF, and additionally LOS and blood loss can be reduced. When comparing parameters, MI-TLIF can be an alternative option for O-TLIF with a similar complication profile. The learning curve of MI-TLIF can be steep, although it depends on the circumstances.
Highlights
Since the introduction of open transforaminal lumbar interbody fusion (O-TLIF) in 1998 by Harms and Jeszenszky, it became an internationally well-known and effectively applied procedure to achieve segmental stability with or without the decompression of the nerve elements in various lumbar degenerative pathologies [1]. e impact of extensive muscle dissection and retraction required in O-TLIF transformed the open technique into a minimally invasive (MI)BioMed Research International one [2], introduced in 2003 by Foley et al e MI-TLIF has the potential benefit of decreasing intraoperative blood loss, surgical site infection (SSI) incidence, time to ambulation, and postoperative length of stay (LOS) [3]
We conducted a study with two arms, comparing the first MI-TLIF and O-TLIF procedures to discern the differences of operative time, intraoperative blood loss, blood transfusion frequencies, LOS, and adverse events (SSI, incidental durotomy, new motoric, sensory deficit, or cauda equina syndrome). e two techniques were compared from the point of their potential to improve the quality of life and relieve the pain as well
Quality of Life and Pain Outcomes. Excluding those patients who needed additional surgery due to an adjacent segment disease, who suffered from other diseases which would have negatively influenced their quality of life or pain evaluation, and who were unreachable for follow-up, 17 O-TLIF and 21 MI-TLIF cases remained for Oswestry Disability Index (ODI) and Visual Analog Score (VAS) comparison (Tables 3 and 4)
Summary
BioMed Research International one [2], introduced in 2003 by Foley et al e MI-TLIF has the potential benefit of decreasing intraoperative blood loss, surgical site infection (SSI) incidence, time to ambulation, and postoperative length of stay (LOS) [3]. It enhances the speed of recovery with the performance of smaller incisions and less soft tissue damage, resulting in clinical outcomes similar to the open procedure [3]. MI-TLIF can be an alternative option for O-TLIF with a similar complication profile. e learning curve of MI-TLIF can be steep, it depends on the circumstances
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