scholarly journals Clinical and Radiographic Comparison Between Open Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion With Bilateral Facetectomies

2020 ◽  
pp. 219256822093287
Author(s):  
Hai Le ◽  
Ryan Anderson ◽  
Eileen Phan ◽  
Joseph Wick ◽  
Joshua Barber ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Operative Time ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Estimated Blood Loss ◽  
Surgical Data ◽  
Open Versus ◽  
Age And Sex

Study Design: Age- and sex-matched cohort study. Objectives: To compare outcomes after open versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with bilateral facetectomies. Methods: We retrospectively compared patients who underwent single- or 2-level MIS-TLIF with an age- and sex-matched open-TLIF cohort. Surgical data was collected for operative time, estimated blood loss (EBL), and drain use. Clinical outcomes included the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), length of stay (LOS), complications, and reoperations. Lumbar radiographs were measured for changes in global lumbar lordosis (LL) and segmental lordosis (SL). Results: Between 2016 and 2020, 38 MIS-TLIF patients were compared with 38 open-TLIF patients. No subfascial drain was used in the MIS-TLIF group ( P < .001). The MIS-TLIF group had longer operative time (310.8 vs 276.5 minutes; P = .046) but less EBL (282.4 vs 420.8 mL; P = .007). LOS ( P = .15), complication rates ( P = .50), and revision rates ( P = .17) were equivalent. VAS and ODI improved but did not differ between groups. In the open-TLIF group, LL and SL were restored or improved in 81.6% and 86.9% of cases, respectively. In the MIS-TLIF group, LL and SL were restored or improved in 86.8% and 97.4% of cases, respectively. There were no differences in changes in LL and SL between groups. Conclusions: Compared with the age- and sex-matched open-TLIF cohort, patients undergoing MIS-TLIF had reduced EBL and subfascial drain use but increased operative time. There were no differences in complications, reoperations, or LOS. Both groups demonstrated improvement in VAS and ODI. MIS-TLIF with bilateral facetectomies provided equivalent improvements in global and segmental LL.

scholarly journals Learning curve and complications of minimally invasive transforaminal lumbar interbody fusion

2013 ◽  
Vol 35 (2) ◽  
pp. E7 ◽  
Author(s):  
Pedro S. Silva ◽  
Paulo Pereira ◽  
Pedro Monteiro ◽  
Pedro A. Silva ◽  
Rui Vaz
Keyword(s):  
Minimally Invasive ◽  
Learning Curve ◽  
Interbody Fusion ◽  
Operative Time ◽  
Pedicle Screws ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Adjacent Level ◽  
Negative Exponential

Object Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has the potential advantage of minimizing soft-tissue damage and reducing recovery time compared to open procedures. A steep learning curve has been described for the technique. The aim of the present study was to define the learning curve that describes the progress of a single surgeon performing the MI-TLIF. Methods One hundred fifty consecutive patients with degenerative lumbar disease who underwent 1- or 2-level MI-TLIF were included in the study. Operative time, corrected operative time per level, and complications were analyzed. The learning curve was assessed using a negative exponential curve-fit regression analysis. Results One hundred ten patients underwent 1-level and 18 patients underwent 2-level MI-TLIF; the remaining 22 underwent a single-level procedure plus an ancillary procedure (decompression at adjacent level, vertebral augmentation through fenestrated pedicle screws, interspinous device at adjacent level). Negative exponential curves appropriately described the relationship between operative time and experience for 1-level surgery and after correction of operative time per level (R2 = 0.65 and 0.57). The median operative time was 140 minutes (interquartile range 120–173 minutes), and a 50% learning milestone was achieved at Case 12; a 90% learning milestone was achieved at Case 39. No patient required transfusion in the perioperative period. The overall complication rate was 12.67% and the most frequent complication was a dural tear (5.32%). Before the 50% and 90% learning milestones, the complication rates were 33% and 20.51%, respectively. Conclusions The MI-TLIF is a reliable and effective option for lumbar arthrodesis. According to the present study, 90% of the learning curve can be achieved at around the 40th case.

scholarly journals Surgical Outcomes for Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion

Neurosurgery ◽  
2015 ◽  
Vol 77 (6) ◽  
pp. 847-874 ◽  
Author(s):  
Nickalus R. Khan ◽  
Aaron J. Clark ◽  
Siang Liao Lee ◽  
Garrett T. Venable ◽  
Nicholas B. Rossi ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Radiation Exposure ◽  
Interbody Fusion ◽  
Operative Time ◽  
Meta Analysis ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Complication Rates ◽  
Lumbar Interbody Fusion

BACKGROUND: Minimally invasive transforaminal lumbar interbody fusion (TLIF)—or MI-TLIF—has been increasing in prevalence compared with open TLIF (O-TLIF) procedures. The use of MI-TLIF is an evolving technique with conflicting reports in the literature about outcomes. OBJECTIVE: To investigate the impact of MI-TLIF in comparison with O-TLIF for early and late outcomes by using the Visual Analog Scale for back pain (VAS-back) and the Oswestry Disability Index (ODI). Secondary end points include blood loss, operative time, radiation exposure, length of stay, fusion rates, and complications between the 2 procedures. METHODS: During August 2014, a systematic literature search was performed identifying 987 articles. Of these, 30 met inclusion criteria. A random-effects meta-analysis was performed by using both pooled and subset analyses based on study type. RESULTS: Our meta-analysis demonstrated that MI-TLIF reduced blood loss (P &lt; .001), length of stay (P &lt; .001), and complications (P = .001) but increased radiation exposure (P &lt; .001). No differences were found in fusion rate (P = .61) and operative time (P = .34). A decrease in late VAS-back scores was demonstrated for MI TLIF (P &lt; .001), but no differences were found in early VAS-back, early ODI, and late ODI. CONCLUSION: MI-TLIF is associated with reduced blood loss, decreased length of stay, decreased complication rates, and increased radiation exposure. The rates of fusion and operative time are similar between MI-TLIF and O-TLIF. Differences in long-term outcomes in MI-TLIF vs O-TLIF are inconclusive and require more research, particularly in the form of large, multi-institutional prospective randomized controlled trials.

Comparison of Early Outcomes between Percutaneous Endoscopic and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spondylolisthesis

2020 ◽  
Author(s):  
Hao Zhang ◽  
Chuanli Zhou ◽  
Chao Wang ◽  
Kai Zhu ◽  
Qihao Tu ◽  
...  
Keyword(s):  
Back Pain ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Operative Time ◽  
Japanese Orthopaedic Association ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Estimated Blood Loss ◽  
Lumbar Spondylolisthesis

Abstract BackgroundWith the rapid development of less-invasive techniques, the percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) as a novel minimal surgical technique for treating lumbar spondylolisthesis in recent years. To compare the preliminary efficacy of Endo-TLIF with that of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of lumbar spondylolisthesis.MethodsBetween May and August 2019, 62 patients with single-segment lumbar spondylolisthesis treated by a single surgeon were enrolled in this clinical study: there were 32 patients in the Endo-TLIF group and 30 patients in the MIS-TLIF group. Perioperative parameters, including operative time, estimated blood loss (EBL), interoperative fluoroscopy time, ambulation time and operative complications, were recorded. At preoperatively, 1 week, 3 months, 6 months and 12 months postoperatively, the results of clinical metrics such as the Visual Analog Scale (VAS) for back pain, the Oswestry Disability Index (ODI) and the Japanese Orthopaedic Association (JOA) score were obtained and used to compare early outcomes between the two groups. Postoperative fusion rates were assessed by CT scans 12 months after surgery.ResultsNo significant differences were found in the demographic data, including sex, age, body mass index (BMI), segment distribution and spondylolisthesis severity, between the two groups. Compared with MIS-TLIF group, Endo-TLIF group had a similar operative time (202.6±31.4 minutes), less intraoperative blood loss (73.0±26.0 ml) and a shorter ambulation time (1.6±0.6 days) but had a longer duration of X-ray radiation (46.3±5.1 seconds). The postoperative VAS scores for back pain as well as the ODI and JOA scores were improved compared with the preoperative scores in the two groups, but the Endo-TLIF group showed more significant improvement in the early follow-up. There were no significant differences in terms of the interbody fusion rate between the two groups. However, no obvious postoperative complications were observed in the study.ConclusionEndo-TLIF technique shows relatively better outcomes compared with MIS-TLIF in terms of an early curative effect, especially one week and six months postoperatively.

Modified Minimally Invasive Transforaminal Lumbar Interbody Fusion Technique Can Potentially Improve Safety of Interbody Graft Placement

2018 ◽  
Vol 15 (3) ◽  
pp. 296-301
Author(s):  
Khalid H Kurtom ◽  
Wendy S Towers
Keyword(s):  
Cerebrospinal Fluid ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Operative Time ◽  
Cerebrospinal Fluid Leak ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Graft Placement ◽  
Estimated Blood Loss ◽  
Fluid Leak

Abstract BACKGROUND Minimally invasive transforaminal lumbar interbody fusion (MITLIF) is a well-described procedure with excellent reported outcomes. A modification of interbody graft placement can potentially improve the ease and safety of this procedure. OBJECTIVE To describe a modification of the MITLIF graft placement and retrospectively review our experience including intraoperative and postoperative complications. METHODS Single surgeon, single institution, retrospective analysis of consecutive patients who underwent a modified MITLIF technique between November 2011 and December 2013. Hospital records including operative notes and discharge summaries were reviewed for patient demographics, surgical parameters including operative time and estimated blood loss, intraoperative complications including durotomy/cerebrospinal fluid leak, and postoperative outcomes including time before ambulation and length of stay were all reviewed and analyzed. RESULTS Eighty-three consecutive MITLIF patients; 71 underwent 1-level fusion and 12 had multilevel fusions. Average operative time for single level was 181 min; multilevel was 323 min. Average estimated blood loss was 140 mL. Time before ambulation was &lt;1 d, average length of stay was 1.6 d. There were a total of 4 complications in this series (4.8%). There was zero incidence of durotomy or cerebrospinal fluid leak. CONCLUSION This modified MITLIF technique of maintaining the medial facet prior to discectomy and interbody graft placement can offer the minimally invasive spine surgeons increased assurance while placing the graft and potentially enhance the overall safety and efficacy of this approach. Surgeons utilizing this approach will have little difficulty utilizing this slight modification.

scholarly journals Clinical outcomes of minimally invasive transforaminal lumbar interbody fusion via a novel tubular retractor

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092009
Author(s):  
Yan Wang ◽  
Yaqing Zhang ◽  
Fanli Chong ◽  
Yue Zhou ◽  
Bo Huang
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Fatty Infiltration ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Cerebrospinal Fluid Leakage ◽  
Lumbar Interbody Fusion ◽  
Multifidus Muscle ◽  
Tubular Retractor ◽  
Estimated Blood Loss

Objective To assess the feasibility and clinical results of microscopic minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using a novel tapered tubular retractor that preserves the multifidus. Method A total of 122 patients underwent MIS-TLIF using a tapered tubular retractor system from March 2016 to August 2017. Perioperative parameters and follow-up outcomes were reviewed. Results The follow-up period was 23.95 ± 1.43 months. The operative time averaged 130.48 ± 34.44 minutes. The estimated blood loss was 114.10 ± 96.70 mL. The mean time until ambulation was 16.33 ± 6.29 hours. The average visual analogue scale (leg/waist) and Oswestry Disability Index scores (preoperative to last follow-up) improved from 4.93 ± 2.68/3.74 ± 2.28 to 0.34 ± 0.77/0.64 ± 0.74 and from 59.09% ± 22.34 to 17.04% ± 8.49, respectively. At the last follow-up, 98.36% of the patients achieved solid fusion. Cerebrospinal fluid leakage occurred in two cases. The asymptote of the surgeon’s learning curve occurred at the 25th case. There were no significant differences between the preoperative qualitative and quantitative analyses of multifidus muscle fatty infiltration and those at the final follow-up. Conclusion MIS-TLIF can be performed safely and effectively using this tapered tubular retractor system, which helps preserve the multifidus.

303 Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion: A Prospective Randomized Study

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 263-264
Author(s):  
Anthony Michael DiGiorgio ◽  
Gabriel Claudiu Tender
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Surgical Techniques ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Secondary Outcome ◽  
Low Grade ◽  
Oral Antibiotic ◽  
Lumbar Interbody Fusion ◽  
Estimated Blood Loss

Abstract INTRODUCTION Symptomatic spondylolisthesis patients may benefit from surgical decompression and stabilization. The standard (S) technique is a transforaminal lumbar interbody fusion (TLIF). Newer, minimally invasive (MI) techniques seem to provide similar results with less morbidity. However, prospective studies comparing S versus MI TLIF are rare. METHODS Patients with at least 6 months of symptoms and image-confirmed low-grade spondylolisthesis were enrolled, at a single academic institution, between 2011 and 2015. The patients were randomized to either S or MI TLIF. The primary outcome measure was the Oswestry Disability Index (ODI) improvement at 1 year. Secondary outcome measures included length of operation, estimated blood loss, length of hospitalization, and fusion rates at 1 year. Complications were also recorded. RESULTS >Forty patients were enrolled in each group. There was no crossover between groups. The age was 50.12 +/−11.09 years in the S TLIF group and 51.3 +/−9.36 years in the MI TLIF group. The mean operative time and estimated blood loss in the S versus MI TLIF group were 297 +/−101 versus 323 +/−85 minutes and 417 +/−211 versus 351 +/−198 ml, respectively. There were 4 transfusions in the S TLIF and 3 transfusions in the MI TLIF group. The patients were discharged after surgery at 4.12 +/−0.88 days for the S TLIF group and 1.92 +/−0.52 days for the MI TLIF group. The ODI improved from 37 +/−6 to 11 +/−6 in the S TLIF group (ODI difference: 26 +/−7) and from 38 +/−7 to 11 +/−6 in the MI TLIF group (ODI difference: 26 +/−8). In both groups, the fusion was considered solid (Grade I) in 36 (90%) and partial (Grade II) in 4 (10%) patients at 1 year. There were no reoperations for pseudarthrosis or any other postoperative complication. There were 2 superficial wound infections in the standard TLIF group, which resolved with oral antibiotic treatment alone. CONCLUSION The standard and minimally invasive TLIF in patients with symptomatic spondylolisthesis provided similar clinical and radiological outcomes at 1 year. The patients undergoing MI TLIF had a shorter hospital stay. Both surgical techniques yielded good results at 1 year.

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 Standard versus Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Prospective Randomized Study

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Daniel Serban ◽  
Niki Calina ◽  
Gabriel Tender
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Randomized Study ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Low Grade ◽  
Lumbar Interbody Fusion ◽  
Estimated Blood Loss

Symptomatic spondylolisthesis patients may benefit from surgical decompression and stabilization. The standard (S) technique is a transforaminal lumbar interbody fusion (TLIF). Newer, minimally invasive (MI) techniques seem to provide similar results with less morbidity. We enrolled patients with at least 6 months of symptoms and image-confirmed low-grade spondylolisthesis, at a single academic institution, between 2011 and 2015. The patients were randomized to either S or MI TLIF. The primary outcome measure was the Oswestry Disability Index (ODI) improvement at 1 year. Secondary outcome measures included length of operation, estimated blood loss, length of hospitalization, and fusion rates at 1 year. Forty patients were enrolled in each group. The differences in mean operative time and estimated blood loss were not statistically significant between the two groups. The patients were discharged after surgery at 4.12 days for the S TLIF group and 1.92 days for the MI TLIF group. The ODI improvement was similar and statistically significant in both groups. The fusion was considered solid in 36 (90%) of patients at 1 year in both groups. In conclusion, the two techniques provided similar clinical and radiological outcomes at 1 year. The patients undergoing MI TLIF had a shorter hospital stay. This trial is registered with NCT03155789.

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