Introduction: There are many instruments and facilities designed to facilitate the procedure of minimally invasive spine surgery. However, those current instrumentation systems may increase the complexity to accomplish the procedure. Our department developed a specific two small incision surgery for MI-TLIF, and the benefits of this technique could control only one unilateral surgical incision for two-screw insertion, which the length of each wound was as small as 3.0–4.0 cm. In this retrospective study, we compared the intraoperative and postoperative results of novel two incisions technique and traditional four surgical incisions for patients with 1-level MI-TLIF treatment.
Methods: We retrospective recruited 80 consecutive patients who had degenerative spinal stenosis or spondylolisthesis and received primary 1-level MI-TLIF in single hospital from September 10, 2020, to October 19, 2023. The Wiltse approach for interbody fusion and a single-plane fluoroscopy-guided method to insert the pedicle screws were used. Patients were divided into two groups depending on different surgical techniques. Patient demographics, intraoperative and postoperative data were assessed. The Mann–Whitney U test or Fisher exact test were used to evaluate the data and a p value < 0.05 was considered significant in this study.
Results: A total of 71 patients met the inclusion criteria in this study. The baseline data were similar between novel technique (n = 41, two incisions) and traditional MI-TLIF group (n = 30, four incisions). Among all intraoperative, postoperative and complication categories, the instrumentation time was the only item that showed significant difference, which is shorter in novel technique group (p = 0.034). The difference became more apparent in the obese group (BMI ≥ 27 kg/m2, p = 0.01).
Conclusion: Although the novel technique could reduce the number of surgical incisions compared to traditional MI-TLIF, the intraoperative and postoperative results were similar to the traditional MI-TLIF. Hence the reduction in wound number and the total length of surgical wound does not have obvious benefits in 1-level MI-TLIF patients. However, the less surgical exposure may offer less surgical wounds complications for specific groups, which were immune-compromised, such as diabetics, chronic renal disease, or cancer patients, and the clinical follow-up of specific groups will be planned to perform in the future.
| [1] |
F. Shunwu, Z. Xing, Z. Fengdong, and F. Xiangqian, “Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Treatment of Degenerative Lumbar Diseases,” Spine 35 (2010): 1615–1620, https://doi.org/10.1097/brs.0b013e3181c70fe3.
|
| [2] |
M. Y. Wang, M. D. Cummock, Y. Yu, and R. A. Trivedi, “An Analysis of the Differences in the Acute Hospitalization Charges Following Minimally Invasive Versus Open Posterior Lumbar Interbody Fusion,” Journal of Neurosurgery: Spine 12 (2010): 694–699, https://doi.org/10.3171/2009.12.spine09621.
|
| [3] |
J. D. Schwender, L. T. Holly, D. P. Rouben, and K. T. Foley, “Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF): Technical Feasibility and Initial Results,” Clinical Spine Surgery 18 (2005): S1.
|
| [4] |
G. B. Brodano, K. Martikos, F. Lolli, et al., “Transforaminal Lumbar Interbody Fusion in Degenerative Disk Disease and Spondylolisthesis Grade I: Minimally Invasive Versus Open Surgery,” Journal of Spinal Disorders & Techniques 28 (2015): E559–E564, https://doi.org/10.1097/bsd.0000000000000034.
|
| [5] |
K. H. Lee, W. M. Yue, W. Yeo, H. Soeharno, and S. B. Tan, “Clinical and Radiological Outcomes of Open Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion,” European Spine Journal 21 (2012): 2265–2270, https://doi.org/10.1007/s00586-012-2281-4.
|
| [6] |
C. Seng, M. A. Siddiqui, K. P. L. Wong, et al., “Five-Year Outcomes of Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion: A Matched-Pair Comparison Study,” Spine 38 (2013): 2049–2055, https://doi.org/10.1097/brs.0b013e3182a8212d.
|
| [7] |
K. Singh, S. V. Nandyala, A. Marquez-Lara, et al., “A Perioperative Cost Analysis Comparing Single-Level Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion,” Spine Journal 14 (2014): 1694–1701, https://doi.org/10.1016/j.spinee.2013.10.053.
|
| [8] |
A. P. Wong, Z. A. Smith, J. A. S. Iii, et al., “Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF),” Neurosurgery Clinics of North America 25 (2014): 279–304, https://doi.org/10.1016/j.nec.2013.12.007.
|
| [9] |
S. L. Parker, O. Adogwa, A. Bydon, J. Cheng, and M. McGirt, “Cost-Effectiveness of Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis Associated Low-Back and Leg Pain Over Two Years,” World Neurosurgery 78 (2012): 178–184, https://doi.org/10.1016/j.wneu.2011.09.013.
|
| [10] |
H.-L. Wang, F.-Z. Lü, J.-Y. Jiang, X. Ma, X. L. Xia, and L. X. Wang, “Minimally Invasive Lumbar Interbody Fusion via MAST Quadrant Retractor Versus Open Surgery: A Prospective Randomized Clinical Trial,” Chinese Medical Journal 124 (2011): 3868–3874.
|
| [11] |
N. R. Khan, A. J. Clark, S. L. Lee, G. T. Venable, N. B. Rossi, and K. T. Foley, “Surgical Outcomes for Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion,” Neurosurgery 77 (2015): 847–874, https://doi.org/10.1227/neu.0000000000000913.
|
| [12] |
F. Ringel, M. Stoffel, C. Stüer, and B. Meyer, “Minimally Invasive Transmuscular Pedicle Screw Fixation of the Thoracic and Lumbar Spine,” Neurosurgery 59 (2006): ONS-361-7, https://doi.org/10.1227/01.neu.0000223505.07815.74.
|
| [13] |
N. Amoretti, E. Hovorka, F. Dausse, et al., “Posterior Arthrodesis of the Spine by Percutaneous CT-Guided Application of Screws: Preliminary Report,” Clinical Imaging 29 (2005): 231–234, https://doi.org/10.1016/j.clinimag.2005.03.001.
|
| [14] |
F.-Y. Tsuang, C.-H. Chen, Y.-J. Kuo, et al., “Percutaneous Pedicle Screw Placement Under Single Dimensional Fluoroscopy With a Designed Pedicle Finder—A Technical Note and Case Series,” Spine Journal 17 (2017): 1373–1380, https://doi.org/10.1016/j.spinee.2017.06.022.
|
| [15] |
M. Cappuccio, L. Amendola, S. Paderni, et al., “Complications in Minimally Invasive Percutaneous Fixation of Thoracic and Lumbar Spine Fractures,” Orthopedics 36 (2013): e729–e734, https://doi.org/10.3928/01477447-20130523-16.
|
| [16] |
Y. H. Kuo, C. H. Kuo, T. H. Tu, et al., “Evolution of Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Pre-, Partial-, and Full-Navigation in a 15-Year Cohort,” Spine 50 (2025): 1355–1362, https://doi.org/10.1097/BRS.0000000000005249.
|
| [17] |
K. T. Foley and M. A. Lefkowitz, “Advances in Minimally Invasive Spine Surgery,” Clinical Neurosurgery 49 (2002): 499–517.
|
| [18] |
K. T. Foley, L. T. Holly, and J. D. Schwender, “Minimally Invasive Lumbar Fusion,” Spine 28 (2003): S26–S35, https://doi.org/10.1097/01.brs.0000076895.52418.5e.
|
| [19] |
P. Pakzaban, “Modified Mini-Open Transforaminal Lumbar Interbody Fusion,” Spine 41 (2016): E1124–E1130, https://doi.org/10.1097/brs.0000000000001510.
|
| [20] |
W. C. Hsu, M. R. G. Araneta, A. M. Kanaya, J. L. Chiang, and W. Fujimoto, “BMI Cut Points to Identify At-Risk Asian Americans for Type 2 Diabetes Screening,” Diabetes Care 38 (2015): 150–158, https://doi.org/10.2337/dc14-2391.
|
| [21] |
E. Munting, C. Röder, R. Sobottke, D. Dietrich, E. Aghayev, and Spine Tango Contributors, “Patient Outcomes After Laminotomy, Hemilaminectomy, Laminectomy and Laminectomy With Instrumented Fusion for Spinal Canal Stenosis: A Propensity Score-Based Study From the Spine Tango Registry,” European Spine Journal 24 (2015): 358–368, https://doi.org/10.1007/s00586-014-3349-0.
|
| [22] |
G. Saxler, J. r. K. mer, B. Barden, et al., “The Long-Term Clinical Sequelae of Incidental Durotomy in Lumbar Disc Surgery,” Spine 30 (2005): 2298–2302, https://doi.org/10.1097/01.brs.0000182131.44670.f7.
|
| [23] |
S. I. Tafazal and P. J. Sell, “Incidental Durotomy in Lumbar Spine Surgery: Incidence and Management,” European Spine Journal 14 (2005): 287–290, https://doi.org/10.1007/s00586-004-0821-2.
|
| [24] |
G. A. Baker, A. M. Cizik, R. J. Bransford, et al., “Risk Factors for Unintended Durotomy During Spine Surgery: A Multivariate Analysis,” Spine Journal: Official Journal of the North American Spine Society 12 (2012): 121–126, https://doi.org/10.1016/j.spinee.2012.01.012.
|
| [25] |
F. Strömqvist, B. Jönsson, and B. Strömqvist, Surgeons SS of S“Dural Lesions in Decompression for Lumbar Spinal Stenosis: Incidence, Risk Factors and Effect on Outcome,” European Spine Journal 21 (2012): 825–828, https://doi.org/10.1007/s00586-011-2101-2.
|
| [26] |
A. Desai, P. A. Ball, K. Bekelis, et al., “SPORT: Does Incidental Durotomy Affect Longterm Outcomes in Cases of Spinal Stenosis?,” Neurosurgery 76 (2015): S57–S63, https://doi.org/10.1227/01.neu.0000462078.58454.f4.
|
| [27] |
P. Lee, J. C. Liu, and R. G. Fessler, “Perioperative Results Following Open and Minimally Invasive Single-Level Lumbar Discectomy,” Journal of Clinical Neuroscience 18 (2011): 1667–1670, https://doi.org/10.1016/j.jocn.2011.04.004.
|
| [28] |
C.-L. Ang, B. P.-B. Tow, S. Fook, et al., “Minimally Invasive Compared With Open Lumbar Laminotomy: No Functional Benefits at 6 or 24 Months After Surgery,” Spine Journal 15 (2015): 1705–1712, https://doi.org/10.1016/j.spinee.2013.07.461.
|
RIGHTS & PERMISSIONS
2026 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
PDF
(1028KB)
