Application of a three-dimensional high-definition exoscope in minimally invasive transforaminal lumbar interbody fusion

Abstract Background Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is becoming increasingly popular in the treatment of lumbar degenerative diseases. Microscope assisted MIS-TLIF was also reported favorable clinical outcomes and low complication rates, while limitations can include depth of field, illumination, and ergonomics. The exoscope has been introduced as an alternative to microscopes. In this report, we describe the application of the 3-dimensional (3D), high-definition (HD) exoscope for MIS-TLIF, and discuss its advantages and disadvantages. Methods Six patients were performed 3D-HD exoscope-assisted MIS-TLIF from September 2019 to December 2019. The exoscope was used [Kestrel View II, WEALTH CONCORD MITAKA MEDICAL TECHNOLOGIESCO., LTD. OF SHANGHAI, CHINA] during soft tissue dissection, discectomy, decompression, and cage insertion. Results The exoscope provided an excellent 3D view of the surgical field and allowed us to effectively and safely perform the surgical steps. All 6 patients experienced excellent surgical outcomes. The main advantages of the 3D exoscope include the possibility to provide excellent, magnified, and illuminated 3D-HD images of the surgical field to the entire operating room and serving as an excellent training tool. Conclusion We believe that the 3D exoscope will be a safe and effective tool to perform MIS-TLIF.

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Learning curve and complications of minimally invasive transforaminal lumbar interbody fusion

Neurosurgical FOCUS ◽

10.3171/2013.5.focus13157 ◽

2013 ◽

Vol 35 (2) ◽

pp. E7 ◽

Cited By ~ 37

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.

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Surgical Outcomes for Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion

Neurosurgery ◽

10.1227/neu.0000000000000913 ◽

2015 ◽

Vol 77 (6) ◽

pp. 847-874 ◽

Cited By ~ 90

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 < .001), length of stay (P < .001), and complications (P = .001) but increased radiation exposure (P < .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 < .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.

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MICROSURGICAL LANDMARKS IN MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION

Coluna/Columna ◽

10.1590/s1808-185120151404152838 ◽

2015 ◽

Vol 14 (4) ◽

pp. 317-319 ◽

Cited By ~ 2

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.

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

Global Spine Journal ◽

10.1177/2192568220932879 ◽

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.

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Impact of Iliac Crest Bone Grafting on Postoperative Outcomes and Complication Rates Following Minimally Invasive Transforaminal Lumbar Interbody Fusion

Neurospine ◽

10.14245/ns.1938006.003 ◽

2019 ◽

Vol 16 (4) ◽

pp. 772-779

Author(s):

Brittany E. Haws ◽

Benjamin Khechen ◽

Dil V. Patel ◽

Joon S. Yoo ◽

Jordan A. Guntin ◽

...

Keyword(s):

Minimally Invasive ◽

Bone Grafting ◽

Interbody Fusion ◽

Iliac Crest ◽

Transforaminal Lumbar Interbody Fusion ◽

Postoperative Outcomes ◽

Complication Rates ◽

Lumbar Interbody Fusion ◽

Iliac Crest Bone Grafting

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

Journal of Neurosurgery Spine ◽

10.3171/2019.6.spine1965 ◽

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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