scholarly journals Letter to the Editor: Disc Space Preparation in Transforaminal Lumbar Interbody Fusion: A Comparison of Minimally Invasive and Open Approaches

2014 ◽  
Vol 472 (10) ◽  
pp. 3243-3243 ◽  
Author(s):  
Changkun Zheng ◽  
Jian-Jun Wu
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Letter To The Editor

scholarly journals Disc Space Preparation in Transforaminal Lumbar Interbody Fusion: A Comparison of Minimally Invasive and Open Approaches

2014 ◽  
Vol 472 (6) ◽  
pp. 1800-1805 ◽  
Author(s):  
Jeffrey A. Rihn ◽  
Sapan D. Gandhi ◽  
Patrick Sheehan ◽  
Alexander R. Vaccaro ◽  
Alan S. Hilibrand ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Disc Space

Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation

2005 ◽  
Vol 3 (2) ◽  
pp. 98-105 ◽  
Author(s):  
Robert E. Isaacs ◽  
Vinod K. Podichetty ◽  
Paul Santiago ◽  
Faheem A. Sandhu ◽  
John Spears ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Pedicle Screws ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Hospital Length Of Stay ◽  
Lumbar Interbody Fusion ◽  
Intraoperative Blood Loss ◽  
Disc Space ◽  
Single Level

Object The authors have developed a novel technique for percutaneous fusion in which standard microendoscopic discectomy is modified. Based on data obtained in their cadaveric studies they considered that this minimally invasive interbody fusion could be safely implemented clinically. The authors describe their initial experience with a microendoscopic transforaminal lumbar interbody fusion (METLIF) technique, with regard to safety in the placement of percutaneous instrumentation, perioperative morbidity, and early postoperative results. Methods The METLIF procedure was performed unilaterally in 20 patients with single-level lumbar spondylolisthesis or pure mechanical back pain with endoscopic assistance, hemilaminectomy, unilateral facetectomy, and microdiscectomy. Two interbody grafts were placed via the lateral exposure of the disc space. Bilateral percutaneous pedicle screws were then inserted. Compared with patients who had undergone single-level posterior LIF at the same institutions, intraoperative blood loss, hospital length of stay (LOS), and postoperative narcotic agent use were significantly lower in the METLIF group. The mean LOS for the percutaneous fusion group was 3.4 days (5.1 days in those who underwent PLIF; p < 0.02). There have been no procedure-related complications in this series to date. Conclusions The METLIF technique provided an option for percutaneous interbody fusion similar to that in open surgery while minimizing destruction to adjacent tissues. This technique was safe and exhibited a trend toward decreased intraoperative blood loss, postoperative pain, total narcotic use, and the risk of transfusion.

Minimally Invasive Transforaminal Lumbar Interbody Fusion: 2-Dimensional Surgical Video

2019 ◽  
Vol 17 (2) ◽  
pp. E53-E53
Author(s):  
Joseph H McMordie ◽  
Eric X Chen ◽  
Landon D Ehlers ◽  
Christopher C Gillis
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Patient Positioning ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Intraoperative Navigation ◽  
Radiographic Evaluation ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Invasive Approach ◽  
Percutaneous Pedicle Screw

Abstract This operative video is a detailed look at minimally invasive transforaminal lumbar interbody fusion. We provide a step-by-step guide with appropriate narration and operative video to enhance the educational experience. We review clinical and radiographic evaluation, patient positioning, intraoperative navigation, localization, percutaneous pedicle screw placement, minimally invasive approach, disc space preparation, placement of interbody device, and closure. By presenting up-to-date minimally invasive and intraoperative navigation techniques, this video provides educational benefit to all neurosurgeons regardless of training level.

Minimally Invasive Transforaminal Lumbar Interbody Fusion With Intraoperative Fluoroscopy for Disc Space Preparation: Analysis of Fusion Rate and Clinical Results

2020 ◽  
Vol 19 (5) ◽  
pp. 557-566
Author(s):  
Guang-Xun Lin ◽  
Sagar Sharma ◽  
Gang Rui ◽  
Myung-Soo Song ◽  
Jin-Sung Kim
Keyword(s):  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Lateral View ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Intraoperative Fluoroscopy ◽  
Cage Subsidence

Abstract BACKGROUND Meticulous disc space preparation is an important step toward ensuring arthrodesis in the interbody fusion procedure. Although minimally invasive techniques are becoming increasingly advanced in lumbar interbody fusion, concerns exist regarding adequate discectomy and sufficient endplate preparation from a transforaminal lumbar approach. OBJECTIVE To describe the radiographic and clinical outcomes of single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) using the intraoperative fluoroscopy-guided method for disc space preparation. METHODS This is a retrospective study of 25 patients operated between June 2016 and Dec 2017. The radiographic outcomes included the intraoperative percentage of disc space preparation, fusion, and subsidence. Percentage of disc space preparation was calculated through intraoperative fluoroscopic imaging. Clinical outcomes included visual analog scale (VAS), Oswestry Disability Index (ODI), and satisfaction rate. RESULTS Mean age of patients was 62.9 yr. The mean follow-up period was 22 mo. Mean extents of disc space preparation were 61.5% in the anteroposterior view and 80.3% in the lateral view. Fusion rates were 86% and 92% at 6 and 12-mo postoperatively, respectively. All patients showed clinical improvement according to VAS and ODI. CONCLUSION MI-TLIF with intraoperative fluoroscopy-guided disc space preparation is shown to lead to potentially improved fusion rate. It is a safe and effective surgical method for degenerative lumbar disease. Additionally, in cases of cage subsidence caused by the endplate violation during disc space preparation, thorough sufficient bone grafting of the defect region avoids pseudoarthrosis.

Cost-effectiveness of minimally invasive midline lumbar interbody fusion versus traditional open transforaminal lumbar interbody fusion

2020 ◽  
Vol 32 (1) ◽  
pp. 31-35
Author(s):  
Mladen Djurasovic ◽  
Jeffrey L. Gum ◽  
Charles H. Crawford ◽  
Kirk Owens ◽  
Morgan Brown ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Smoking Status ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Direct Costs ◽  
Lumbar Interbody Fusion ◽  
Related Quality ◽  
Health Related

OBJECTIVEThe midline transforaminal lumbar interbody fusion (MIDLIF) using cortical screw fixation is a novel, minimally invasive procedure that may offer enhanced recovery over traditional open transforaminal lumbar interbody fusion (TLIF). Little information is available regarding the comparative cost-effectiveness of the MIDLIF over conventional TLIF. The purpose of this study was to compare cost-effectiveness of minimally invasive MIDLIF with open TLIF.METHODSFrom a prospective, multisurgeon, surgical database, a consecutive series of patients undergoing 1- or 2-level MIDLIF for degenerative lumbar conditions was identified and propensity matched to patients undergoing TLIF based on age, sex, smoking status, BMI, diagnosis, American Society of Anesthesiologists Physical Status Classification System (ASA) class, and levels fused. Direct costs at 1 year were collected, including costs associated with the index surgical visit as well as costs associated with readmission. Improvement in health-related quality of life was measured using EQ-5D and SF-6D.RESULTSOf 214 and 181 patients undergoing MIDLIF and TLIF, respectively, 33 cases in each cohort were successfully propensity matched. Consistent with propensity matching, there was no difference in age, sex, BMI, diagnosis, ASA class, smoking status, or levels fused. Spondylolisthesis was the most common indication for surgery in both cohorts. Variable direct costs at 1 year were $2493 lower in the MIDLIF group than in the open TLIF group (mean $15,867 vs $17,612, p = 0.073). There was no difference in implant (p = 0.193) or biologics (p = 0.145) cost, but blood utilization (p = 0.015), operating room supplies (p < 0.001), hospital room and board (p < 0.001), pharmacy (p = 0.010), laboratory (p = 0.004), and physical therapy (p = 0.009) costs were all significantly lower in the MIDLIF group. Additionally, the mean length of stay was decreased for MIDLIF as well (3.21 vs 4.02 days, p = 0.05). The EQ-5D gain at 1 year was 0.156 for MIDLIF and 0.141 for open TLIF (p = 0.821). The SF-6D gain at 1 year was 0.071 for MIDLIF and 0.057 for open TLIF (p = 0.551).CONCLUSIONSCompared with patients undergoing traditional open TLIF, those undergoing MIDLIF have similar 1-year gains in health-related quality of life, with total direct costs that are $2493 lower. Although the findings were not statistically significant, minimally invasive MIDLIF showed improved cost-effectiveness at 1 year compared with open TLIF.

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