Comparison of Minimally Invasive Versus Open Transforaminal Interbody Lumbar Fusion

• Type of Material: Article
• Authors: Kirk Easley, Emory University; Jun-Seok Lee, Emory University; Jae-Young Hong, Emory University; Michael Virk, USC Keck School of Medicine; Patrick C. Hsieh, Weill Cornell–New York Presbyterian Hospital; Sangwook Yoon, Emory University; Chi Heon Kim, Seoul National University College of Medicine and Hospital
• Language: English
• Date: 2020-04-01
• Publisher: SAGE Publications Ltd.
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2019.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1177/2192568219882344
• Title of Journal or Parent Work: Global Spine Journal
• Volume: 10
• Issue: 2_suppl
• Start Page: 143S
• End Page: 150S
• Grant/Funding Information: he author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This supplement was supported by funding from the Carl Zeiss Meditec Group.
• Keywords: Outcomes; lumbosacral region; Fluoroscopy; Orthopedics; spine; lumbar interbody fusion; Science & Technology; Neurosciences & Neurology; vertebrae; Navigation; Clinical Neurology; transforaminal; Traditional open; Life Sciences & Biomedicine; Open surgery
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health; Biology, Neuroscience

Abstract

Study Design: Narrative review. Objectives: In this review, we address the question of whether the literature supports the notion that minimally invasive transforaminal interbody fusion (MIS-TLIF) improves outcome as compared with open TLIF (open-TLIF). Short and long-term outcomes, fusion rate, and cost-effectiveness were reviewed. Methods: This is a narrative review using various databases. Open-TLIF and MIS-TLIF studies were included and posterior lumbar interbody fusion studies were excluded. A description of paramedian incision in surgical technique was essential to the definition of MIS-TLIF. The present review included 14 prospective observational studies and 6 randomized controlled trials. Results: With short-term outcomes, some studies indicate a better outcome with MIS-TLIF regarding intraoperative bleeding, hospital stay, time to ambulation, postoperative narcotic use, and time to resume work. Both MIS-TLIF and open-TLIF surgeries improved Oswestry Disability Index, back pain, and leg pain. Some studies show that MIS-TLIF resulted in lower back pain than open-TLIF. Radiation exposure was higher with MIS-TLIF. In the longer term, clinical outcomes were improved in both MIS and open TLIF groups. Fusion rates were more than 90% in both MIS-TLIF and open-TLIF. Cost-effectiveness and length of surgery had mixed results. Conclusions: The potential benefits of MIS-TLIF might be present in the early recovery period after surgery. Long-term outcomes were similar with both MIS-TLIF and open-TLIF.