Classification of Minimally Invasive Techniques for Transforaminal Lumbar Interbody Fusion

✓ Lumbar fusion is a commonly performed procedure for a variety of pathological conditions, and it is frequently used in the treatment of degenerative lumbar instability that is refractory to medical management. Pedicle screws and interbody devices have been used for internal fixation to promote arthrodesis, prevent nonunion, and facilitate early mobilization. Recently, attempts have been made to reduce the morbidity associated with lumbar fusion by using a variety of minimally invasive techniques. Many minimally invasive lumbar fusion procedures require specialized retractors, implants, image guidance systems, or insertion instruments. Other minimally invasive techniques are primarily applied to an ideal patient population (thin, healthy, and with no previous surgery). The authors describe their experience with a paramedian approach for minimally invasive transforaminal lumbar interbody fusion (TLIF) with unilateral pedicle screw (PS) fixation. This procedure requires only standard implants, instruments, and retractors, with direct visualization for all aspects of the procedure. The authors describe encouraging early results in a challenging patient population in which there was a high incidence of obesity, medical comorbidities, and previous surgery at the same level. The paramedian approach for TLIF performed using unilateral lumbar PSs has yielded successful outcomes in this series of 47 patients, and further study of this technique may help define its role as a minimally invasive procedure for spinal fusion.

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Minimally invasive tubular surgery for transforaminal lumbar interbody fusion

Neurosurgical FOCUS ◽

10.3171/2013.v2.focus13227 ◽

2013 ◽

Vol 35 (v2supplement) ◽

pp. Video19 ◽

Cited By ~ 2

Author(s):

Jon Kimball ◽

Andrew Yew ◽

Ruth Getachew ◽

Daniel C. Lu

Keyword(s):

Minimally Invasive ◽

Posterior Approach ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Postoperative Patient ◽

Common Procedure ◽

Circumferential Fusion ◽

Single Posterior Approach ◽

Invasive Techniques

Transforaminal lumbar interbody fusion (TLIF) was originally developed as a method for circumferential fusion via a single posterior approach and is now an extremely common procedure for the treatment of lumbar instability. More recently, minimally invasive techniques have been applied to this procedure with the goal of decreasing tissue disruption, blood loss and postoperative patient discomfort. Here we describe a minimally invasive tubular TLIF on a 60-year-old male with radiculopathy from an unstable L4–5 spondylolisthesis.The video can be found here: http://youtu.be/0BbxQiUmtRc.

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COMPLICATIONS IN THREE LUMBAR ARTHRODESIS TECHNIQUES: TLIF, MITLIF, PLIF

Coluna/Columna ◽

10.1590/s1808-185120171601139900 ◽

2017 ◽

Vol 16 (1) ◽

pp. 74-77 ◽

Cited By ~ 1

Author(s):

AVELINO AGUILAR MERLO ◽

RICARDO ROJAS BECERRIL ◽

MARIO LORETO LUCAS ◽

SHEILA PATRICIA VÁZQUEZ ARTEAGA

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Lumbar Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Spine Surgeon ◽

Lumbar Spondylolisthesis ◽

Incidental Durotomy ◽

Invasive Techniques

ABSTRACT Objective: To determine that minimally invasive transforaminal lumbar fusion has fewer complications of chronic lumbar instability compared with traditional open techniques. Methods: Retrospective, observational study of 132 patients with grade I and II lumbar spondylolisthesis with advanced disc degeneration. Forty-five patients operated by minimally invasive transforaminal lumbar interbody fusion (MITLIF), 45 patients operated by posterior lumbar interbody fusion (PLIF) and 42 patients operated by open transforaminal lumbar interbody fusion (TLIF). Results: Four patients had incidental durotomy, two in the TLIF group and two in the PLIF group. There were no cases of incidental durotomy in the minimally invasive transforaminal access group. No patient in the study presented an inadequate screw position, the lowest mean bleeding occurred in the group of minimally invasive instrumentation of one and two levels. There were 6.6% of infections for PLIF group and none in the other two groups. Conclusions: Arthrodesis techniques are not free of complications, however, the frequency is lower with minimally invasive techniques. Nonetheless, it requires training and does not dispense the need for a learning curve for the spine surgeon compared to open lumbar fusion techniques.

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Two-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: Surgical Technique and Illustrative Cases

ISRN Minimally Invasive Surgery ◽

10.1155/2013/143029 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8

Author(s):

Rory J. Petteys ◽

Jay Rhee ◽

Jean-Marc Voyadzis

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Wound Complications ◽

Foraminal Stenosis ◽

Lumbar Interbody Fusion ◽

Review Of The Literature ◽

Disc Disease ◽

Common Procedure ◽

Invasive Techniques

Transforaminal lumbar interbody fusion (TLIF) is a common procedure performed by spine surgeons. The indications for TLIF include back pain and radiculopathy as a consequence of canal or foraminal stenosis, degenerative disc disease, spondylolisthesis, or deformity. Minimally invasive techniques (MIS) have proven to be effective for single-level TLIF and are associated with less blood loss, fewer wound complications and infections, faster recovery, and decreased hospital cost. To date, there is very little data on 2-level MIS TLIF. We present our technique for 2-level MIS TLIF with case illustrations and a review of the literature.

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Anterior and Posterior Lumbar Interbody Fusion With Percutaneous Pedicle Screws: Comparison to Muscle Damage and Minimally Invasive Techniques

Yearbook of Orthopedics ◽

10.1016/s0276-1092(10)79693-0 ◽

2010 ◽

Vol 2010 ◽

pp. 290-291

Author(s):

P.M. Huddleston

Keyword(s):

Minimally Invasive ◽

Muscle Damage ◽

Interbody Fusion ◽

Pedicle Screws ◽

Posterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Minimally Invasive Techniques ◽

Invasive Techniques

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Comparison of open and minimally invasive techniques for posterior lumbar instrumentation and fusion after open anterior lumbar interbody fusion

The Spine Journal ◽

10.1016/j.spinee.2012.10.034 ◽

2013 ◽

Vol 13 (5) ◽

pp. 489-497 ◽

Cited By ~ 14

Author(s):

Christopher K. Kepler ◽

Anthony L. Yu ◽

Jordan A. Gruskay ◽

Lawrence A. Delasotta ◽

Kristen E. Radcliff ◽

...

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Anterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Minimally Invasive Techniques ◽

Invasive Techniques

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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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