scholarly journals Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Perspective on Current Evidence and Clinical Knowledge

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Ali Habib ◽  
Zachary A. Smith ◽  
Cort D. Lawton ◽  
Richard G. Fessler
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Modern Method ◽  
Current Evidence ◽  
Invasive Technique ◽  
Published Data ◽  
Lumbar Interbody Fusion ◽  
Patient Reported ◽  
Duration Of Surgery

This paper reviews the current published data regarding open transforaminal lumbar interbody fusion (TLIF) in relation to minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).Introduction. MI-TLIF, a modern method for lumbar interbody arthrodesis, has allowed for a minimally invasive method to treat degenerative spinal pathologies. Currently, there is limited literature that compares TLIF directly to MI-TLIF. Thus, we seek to discuss the current literature on these techniques.Methods. Using a PubMed search, we reviewed recent publications of open and MI-TLIF, dating from 2002 to 2012. We discussed these studies and their findings in this paper, focusing on patient-reported outcomes as well as complications.Results. Data found in 14 articles of the literature was analyzed. Using these reports, we found mean follow-up was 20 months. The mean patient study size was 52. Seven of the articles directly compared outcomes of open TLIF with MI-TLIF, such as mean duration of surgery, length of post-operative stay, blood loss, and complications.Conclusion. Although high-class data comparing these two techniques is lacking, the current evidence supports MI-TLIF with outcomes comparable to that of the traditional, open technique. Further prospective, randomized studies will help to further our understanding of this minimally invasive technique.

scholarly journals Impact of local steroid application in a minimally invasive transforaminal lumbar interbody fusion: results of a prospective, randomized, single-blind trial

2019 ◽  
Vol 30 (2) ◽  
pp. 222-227 ◽  
Author(s):  
Brittany E. Haws ◽  
Benjamin Khechen ◽  
Dil V. Patel ◽  
Mundeep S. Bawa ◽  
Junyoung Ahn ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Perioperative Outcomes ◽  
Inpatient Stay ◽  
Lumbar Interbody Fusion ◽  
Acute Postoperative Pain ◽  
Estimated Blood Loss ◽  
Patient Reported

OBJECTIVELocal epidural steroid application may be associated with decreased pain and narcotic use in the immediate postoperative period following lumbar discectomy. However, local steroid delivery following lumbar fusion procedures has not been well characterized. This study aims to characterize the effect of local intraoperative depomedrol application on perioperative and postoperative outcomes following a single-level minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).METHODSA prospective, randomized, single-blinded study was performed. A priori power analysis determined that 86 patients were needed to detect a difference of 1 point in the visual analog scale (VAS) pain score between groups. Ninety-three patients were randomized into depomedrol (DEPO) and no depomedrol (NODEPO) cohorts. Prior to surgical closure, DEPO patients received 1 ml depomedrol (80 mg) applied directly to the surgical site by using a Gelfoam carrier. NODEPO patients received 1 ml saline on the same Gelfoam carrier. Perioperative outcomes including acute postoperative pain and narcotic use were assessed for the duration of inpatient stay. Patient-reported outcomes (PROs) questionnaires including VAS back and leg pain scores, and Oswestry Disability Index (ODI) were administered preoperatively and at 6-week, 12-week, and 6-month follow-up. Outcomes for DEPO and NODEPO cohorts were compared using linear regression controlled for sex.RESULTSOf the 93 patients, 45 (48.4%) were randomized to DEPO and 48 (51.6%) to NODEPO. A greater percentage of DEPO patients were female (53.3% vs 27.1%, p = 0.010). There were no other significant differences in patient baseline characteristics. Similarly, operating time, estimated blood loss, and length of inpatient stay did not differ between cohorts. Patients in the DEPO cohort consumed fewer hourly narcotics on postoperative day 0 (5.3 vs 6.3 oral morphine equivalents/hour, p = 0.034). However, no differences in acute postoperative pain or total narcotics consumption were observed between groups. Preoperative VAS leg scores were statistically different between cohorts (p = 0.027). However, preoperative ODI and VAS back scores did not differ between groups. Additionally, DEPO and NODEPO groups experienced similar improvements in PROs at all postoperative time points.CONCLUSIONSLocal depomedrol use did not lead to decreases in acute postoperative pain or narcotics consumption after MIS TLIF. Additionally, local depomedrol was not associated with postoperative improvements in PROs. The findings of this randomized trial suggest that surgical and clinical outcomes following MIS TLIF may not be impacted by intraoperative application of depomedrol.Clinical trial registration no.: NCT03308084 (clinicaltrials.gov)

scholarly journals Minimally invasive versus open transforaminal lumbar interbody fusion: a meta-analysis based on the current evidence

2013 ◽  
Vol 22 (8) ◽  
pp. 1741-1749 ◽  
Author(s):  
Nai-Feng Tian ◽  
Yao-Sen Wu ◽  
Xiao-Lei Zhang ◽  
Hua-Zi Xu ◽  
Yong-Long Chi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Meta Analysis ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Current Evidence ◽  
Lumbar Interbody Fusion

scholarly journals Are Patient-Reported Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion Influenced by Preoperative Mental Health?

2020 ◽  
pp. 219256822091271 ◽  
Author(s):  
Graham S. Goh ◽  
Ming Han Lincoln Liow ◽  
Wai-Mun Yue ◽  
Seang-Beng Tan ◽  
John Li-Tat Chen
Keyword(s):  
Mental Health ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Short Form ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Patient Reported Outcome Measures ◽  
Leg Pain ◽  
Lumbar Interbody Fusion ◽  
Sf 36 ◽  
Patient Reported

Study design: This was a retrospective review of prospectively collected data. Objectives: Few studies have described the relationship between mental health and patient-reported outcome measures (PROMs) after minimally invasive spine surgery. Prior studies on open surgery included small cohorts with short follow-ups. Methods: Patients undergoing primary minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative pathology were retrospectively reviewed and stratified by Short Form (SF-36) Mental Component Summary (MCS): low MCS (<50, n = 436) versus high MCS (≥50, n = 363). PROMs assessed were back pain, leg pain, North American Spine Society Neurogenic Symptoms, Oswestry Disability Index, SF-36 Physical Component Summary, and MCS. Satisfaction, expectation fulfilment, and return to work (RTW) rates also were recorded at 1 month, 3 months, 6 months, and 2 years. Results: Preoperative MCS was 39.4 ± 8.6 and 58.5 ± 5.4 in the low and high MCS groups, respectively ( P < .001). The low MCS group had significantly poorer preoperative PROMs and longer lengths of stay. Despite this, both groups achieved comparable PROMs from 3 months onward. The mean MCS was no longer significantly different by 3 months ( P = .353). The low MCS group had poorer satisfaction ( P = .022) and expectation fulfilment ( P = .020) at final follow-up. RTW rates were initially lower in the low MCS group up to 3 months ( P = .034), but the rates converged from 6 months onward. Conclusions: Despite poorer PROMs preoperatively, patients with poor baseline mental health still achieved comparable results from 3 months up to 2 years after MIS-TLIF. Preoperative optimization of mental health should still be pursued to improve satisfaction and prevent delayed RTW after surgery.

scholarly journals MICROSURGICAL LANDMARKS IN MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION

2015 ◽  
Vol 14 (4) ◽  
pp. 317-319 ◽  
Author(s):  
Javier Quillo-Olvera ◽  
Sergio Soriano-Solis ◽  
Ramses Uriel Ortiz-Leyva ◽  
Carlos Francisco Gutiérrez-Partida ◽  
Manuel Rodríguez-García ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Facet Joint ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Lumbar Interbody Fusion ◽  
Anatomical Models ◽  
Tubular Retractor ◽  
Surgical Field

Microsurgical landmarks of the facet joint complex were defined to provide guidance and security within the tubular retractor during transforaminal surgery. A retrospective observational study was performed in segments L4-L5 by the left side approach. Microsurgical relevant photos, anatomical models and drawing were used to expose the suggested landmarks. The MI-TLIF technique has advantages compared with conventional open TLIF technique, however minimally invasive technique implies lack of security for the surgeon due to the lack of defined microanatomical landmarks compared to open spine surgery, and disorientation within the tubular retractor, the reason why to have precise microsurgical references and its recognition within the surgical field provide speed and safety when performing minimally invasive technique.

Transfacet Minimally Invasive Transforaminal Lumbar Interbody Fusion With an Expandable Interbody Device—Part II: Consecutive Case Series

2020 ◽  
Vol 19 (5) ◽  
pp. 518-529
Author(s):  
Jawad M Khalifeh ◽  
Christopher F Dibble ◽  
Priscilla Stecher ◽  
Ian Dorward ◽  
Ammar H Hawasli ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Rating Scale ◽  
Case Series ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
The Mean

Abstract BACKGROUND Advances in operative techniques and instrumentation technology have evolved to maximize patient outcomes following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). The transfacet MIS-TLIF is a modified approach to the standard MIS-TLIF that leverages a bony working corridor to access the disc space for discectomy and interbody device placement. OBJECTIVE To evaluate clinical and radiographic results following transfacet MIS-TLIF using an expandable interbody device. METHODS We performed a retrospective review of consecutive patients who underwent transfacet MIS-TLIF for degenerative lumbar spondylolisthesis. Patient-reported outcome measures for pain and disability were assessed. Sagittal lumbar segmental parameters and regional lumbopelvic parameters were assessed on upright lateral radiographs obtained preoperatively and during follow-up. RESULTS A total of 68 patients (61.8% male) underwent transfacet MIS-TLIF at 74 levels. The mean age was 63.4 yr and the mean follow-up 15.2 mo. Patients experienced significant short- and long-term postoperative improvements on the numeric rating scale for low back pain (–2.3/10) and Oswestry Disability Index (−12.0/50). Transfacet MIS-TLIF was associated with an immediate and sustained reduction of spondylolisthesis, and an increase in index-level disc height (+0.71 cm), foraminal height (+0.28 cm), and segmental lordosis (+6.83°). Patients with preoperative hypolordosis (&lt;40°) experienced significant increases in segmental (+9.10°) and overall lumbar lordosis (+8.65°). Pelvic parameters were not significantly changed, regardless of preoperative alignment. Device subsidence was observed in 6/74 (8.1%) levels, and fusion in 50/53 (94.3%) levels after 12 mo. CONCLUSION Transfacet MIS-TLIF was associated with clinical improvements and restoration of radiographic sagittal segmental parameters. Regional alignment correction was observed among patients with hypolordosis at baseline.

scholarly journals Evaluations of minimally invasive transforaminal lumbar interbody fusion performed with rhBMP-2

2019 ◽  
Author(s):  
Bin Lv ◽  
Yuting Hou ◽  
Xiang Jin ◽  
Dan Luo ◽  
Lei Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Clinical Data ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Bone Morphogenetic Protein 2 ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Patient Reported ◽  
Cage Subsidence

Abstract Background: The combination of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and recombinant human bone morphogenetic protein 2 (rhBMP-2) is widely used for its advantage of rapid recovery and improved bone fusion. However, no previous study has reported the synergistic effect of MIS-TLIF with rhBMP-2 in patients with degenerative lumbar disease (DLD). Objective: To investigate the radiographic and patient-reported outcomes (PROs) in patients with DLD who underwent MIS-TLIF with and without a low dose of rhBMP-2. Methods: We retrospectively reviewed 48 patients treated with MIS-TLIF from 2013 to 2016. The patients were classified into the rhBMP-2 group (n = 25) and non-rhBMP-2 group (n = 23). Fusion-related parameters were measured before and after the operation. Clinical data included the numeric rating scale (NRS) score, Japanese Orthopedic Association (JOA) scores, and the MOS 36-item short form health survey (SF-36) score, which were documented to evaluate the effect of surgery. Results: In the 48 patients who underwent MIS-TLIF, the operated disc was predominantly at the L4/5 and L5/S1 levels. ADH, MDH, and PDH increased significantly in both groups after surgery (P < 0.05). FH improved in the rhBMP-2 group, but not in the non-rhBMP-2 group. There was no obvious improvement in SA in both groups. Furthermore, the SL showed a significant difference in both groups and a significant improvement over the baseline. The LL showed significant improvement in the two groups at the early follow-up (P < 0.05), but the improvement did not persist. Cage subsidence had no significant effect on different subsidence grades. In addition, no differences in cage subsidence were observed in different types of modic change (MC), except for MC 0 in both groups. There was no difference in PROs even though all clinical outcomes improved significantly during the postoperative follow-up period in both groups. Conclusion: MIS-TLIF with the low doses of rhBMP-2 resulted in an improvement in radiographic and clinical results, but not a longer-lasting restoration for radiographic outcomes. Cage subsidence is not associated with the MC. Further, our clinical data demonstrated no difference between both groups.

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