Minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a technical description and review of the literature

Abstract

Minimally invasive spine surgery (MISS) has been increasingly advocated during the last decade with new studies being reported every year. Minimally invasive spine procedures, such as minimally invasive transforaminal interbody fusion (MI-TLIF), have been introduced to reduce approach-related muscle trauma, to minimise blood loss, and to achieve faster wound healing, quicker ambulation and earlier patient discharge. The aim of this article was to give a comprehensive review of the available English literature comparing open TLIF with MI-TLIF techniques published or available online between 1990 and 2014 as identified by an electronic database search on http://www.ncbi.nlm.nih.gov/pubmed . Fourteen relevant studies comparing MI-TLIF and open TLIF cohorts could be identified. MI-TLIF seems to be a valid alternative to open TLIF. Both methods yield good clinical results with similar improvements of Oswestry Disability Index (ODI) and visual analogue scale (VAS) on follow-up. There seems to be no significant differences in clinical outcome and fusion rates on comparison. These results are consistent throughout all reported studies in this review. The most pronounced benefits of MI-TLIF are a significant reduction of blood loss, shorter lengths of hospital stay (LOHS) and lower surgical site infection rates. On the downside, MI-TLIF seems to be associated with significantly higher intraoperative radiation doses, a shallow learning curve, at least in the beginning, longer operating times and potentially more frequent implant failures/cage displacements and revision surgeries.