Minimally Invasive Transforaminal Lumbar Interbody Fusion for Degenerative Spine

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Transforaminal lumbar interbody fusion (TLIF) is a popular, well established technique for achieving circumferential fusion by a posterior approach. In an effort to minimize surgical approach-related morbidity, surgeons have devised minimally invasive (MIS) techniques that use specialized retractor systems, using muscle-splitting exposure, to provide surgical access directly over the region of interest. The indications for performing a MIS TLIF are similar to the conventional TLIF and include low-grade spondylolisthesis, degenerative disc disease with back pain with or without radiculopathy, and recurrent disc herniations. The surgical indications, contraindications, and an overview of the surgical technique are presented in this review. A systematic literature review was also undertaken to identify studies that compared MIS TLIF with open TLIF. The search revealed 8 controlled cohort studies that have shown significantly lower postoperative morbidity in the MIS TLIF cohorts while having comparable clinical outcomes with open TLIF cohorts. The higher complication rate during the learning curve of this procedure remains a concern. However, the evidence available is of low quality, and well designed prospective controlled trials are needed to decisively prove the benefits observed so far.

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