The Potential Elimination of Blood Transfusions in Lumbar Spine Fusion Surgery: Clinical Case Series of 620 Consecutive Minimally Invasive TLIF Surgeries and Review of the Literature

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Background Lumbar spine fusion is one of the most common surgical procedures performed in the operative management of adult degenerative spine disorders. The dual incision, mini-open TLIF surgery uses a minimally invasive surgical technique that decompresses neural elements through placement of an anterior interbody disc spacer and posterior stabilization with pedicle screws. It is well established that this approach results in significantly less muscle dissection than the open technique used in conventional TLIF, however a quantitative assessment of the need for blood transfusions during this procedure has been limited to relatively small case series. The aim of this study was to assess the incidence of blood transfusion amongst a large group of patients undergoing a mini-open dual incision TLIF procedure over an extended amount of time. A retrospective study was completed of 620 consecutive patients surgically treated with the Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF) procedure, the largest such study completed by a single surgeon at multiple institutions from 2004 to 2020. Methods The study sample comprises 620 patients who underwent a mini-open TLIF procedure through a dual incision technique for treatment of lumbar degenerative diseases from January 2004 to October 2020. No patients who underwent the procedure were excluded from the series. Surgical and medical record review was conducted to determine whether patients required blood transfusions during their hospitalization. No patients were lost to three-month follow up. Results The study group consisted of 620 patients, 332 women and 288 men. Ages ranged from 20 to 88 years old with a mean age of 54 years. No patients in the series required a blood transfusion during their surgery, hospitalization, or 3-month postoperative period. Conclusions The dual incision MIS Mini-open transforaminal lumbar interbody fusion allows for decompression of neural elements, pedicle screw instrumentation, and placement of an anterior interbody cage while potentially eliminating the need for blood transfusions. While previous studies have shown the potential for reduced blood loss with the mini-open technique compared to the open technique, this study adds a significant volume of data-driven evidence to support this conclusion. As such, this study represents the largest single-surgeon case series to show consistent absence of blood transfusions with a mini-open TLIF technique over sixteen years.