Abstract
Transforaminal lumber interbody fusion (TLIF) is the last resort to address the lumber degenerative disorders such as spondylolisthesis, causing lower back pain. The current surgical intervention for these abnormalities includes open TLIF. However, in recent years, minimally invasive TLIF (MIS-TLIF) has gained a high momentum, as it could minimize the risk of infection, blood loss, and post-operative complications pertaining to fusion surgery. Further advancement in visualizing and guiding techniques along with grafting cage and materials are continuously improving the safety and efficacy of MIS-TLIF. These assistive techniques are also playing a crucial role to increase and improve the learning curve of surgeons. However, achieving an appropriate output through TLIF still remains a challenge, which might be synergized through 3D-printing and tissue engineering-based regenerative therapy. Owing to their differentiation potential, biomaterials such as stem/progenitor cells may contribute to restructuring lost or damaged tissues during MIS-TLIF, and this therapeutic efficacy could be further supplemented by platelet-derived biomaterials, leading to improved clinical outcomes. Thus, based on the above-mentioned strategies, we have comprehensively summarized recent developments in MIS-TLIF and its possible combinatorial regenerative therapies for rapid and long-term relief.
Highlights
Spinal surgery is a final and effective resort to overcome the spinal degenerative disorders, spondylolisthesis, neoplasia, tumors, infection, and trauma [1,2,3]
Smoking may adversely influence the internal region of the intervertebral disc (IVD) by imparting vasoconstriction, leading to a reduced supply of nutrients and growth factor to disc tissue, which further suppress glycosaminoglycans and cell density [82,83]. While addressing this pathologic condition, MIS-Transforaminal lumber interbody fusion (TLIF) is effective in reducing blood loss, frequency of shortterm pain, complications, and recovery time in comparison to posterior lumbar interbody fusion (PLIF) among obese patients; the operative time in MIS-TLIF was much longer than PLIF [84]
MIS-TLIF is becoming a popular choice for lumbar arthrodesis, and choices of materials for bone fusion are continuously improving spinal fusion
Summary
Spinal surgery is a final and effective resort to overcome the spinal degenerative disorders, spondylolisthesis, neoplasia, tumors, infection, and trauma [1,2,3]. Lumbar interbody fusion (LIF) is a surgical intervention to overcome degenerated lumber segments and its decompressed neural components as well as related facet joints abnormalities [5]. Progresses have been made to improve the surgical procedure, materials, and instrument to reduce the length of stay and radiation exposure during MIS-TLIF, as prolonged exposure may adversely affect patient’s health and recovery time [12]. The technical and instrumental developments have significantly improved the learning curve and surgical efficacy [17], the potential of regenerative therapeutic biomaterials for spinal disorders is being explored to achieve the utmost clinical outcomes [18]. Under the umbrella of regenerative therapies, stem cells and platelet-rich plasma (PRP) possess immense potential to improve the therapeutic safety and efficacy of MIS-TLIF [22,23,24]
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