Minimally invasive transforaminal lumbar interbody fusion

Abstract

Instrumented fusion of lumbar motion segments using aminimally invasive technique. Degenerative disc disease, segmental degeneration, degenerative spondylolisthesis, isthmic spondylolisthesis, pseudarthrosis, other spinal lumbar instabilities, disc prolapse, revision for failed back surgery syndrome, unilateral neuroforaminal stenosis, facet joint arthrosis. High-grade spondylolisthesis (Meyerding gradesIII/IV, spondyloptosis), bilateral nerve root compression, vertebral fractures, tumors, high-grade spinal instabilities, primary spinal deformities, multilevel pathologies. Ipsilateral minimally invasive approach using aself-retaining tubular retractor system, partial or complete facetectomy, insertion of pedicle screws, transforaminal lumbar interbody fusion (TLIF) cage insertion preserving nerve roots, fusion, contralateral insertion of pedicle screws using aminimally invasive or percutaneous technique. Mobilization with physiotherapy, followed by standing plain x‑ray examinations, clinical and radiological follow-up at 6-12weeks and 1year postoperatively. Fusion rates >90%, comparable to open TLIF. Complication rates lower than open TLIF. Shorter radiation exposure during surgery, lower blood loss. Less surgical trauma leads to shorter hospitalization time and earlier return-to-work. Oswestry Disability index (ODI) scores and visual analog scale (VAS) scores significantly decreased.