Clinical and Radiologic Comparison of Minimally Invasive Surgery With Traditional Open Transforaminal Lumbar Interbody Fusion: A Review of 452 Patients From a Single Center

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Abstract

Study Design:

Retrospective analysis of prospective data for parallel, consecutive series of patients (Level III).

Objective:

Compare clinical results and radiographic outcomes of minimally invasive surgery (MIS) versus open techniques for transforaminal lumbar interbody fusion (TLIF).

Summary of Background Data:

Minimally invasive techniques allow transforaminal exposure with decreased soft tissue disruption, but the question remains whether surgical and functional outcomes are equivalent to open techniques.

Materials and Methods:

A consecutive series of 452 1 or 2-level TLIF patients at a single institution between 2002 and 2008 were analyzed. A total of 148 were MIS patients and 304 were open. Operative time, estimated blood loss, infection rate, and hospital length of stay were recorded. Oswestry disability index (ODI) and visual analog (VAS) pain scores were documented preoperatively and postoperatively. Fusion was assessed radiologically at a minimum of 1 year follow-up.

Results:

There were proportionally more 2-level than 1-level procedures in the open group compared with the MIS group; there were more Workers’ Compensation patients among 1-level procedures than 2-level. There were more Spondylolisthesis patients and fewer Degenerative Disk Disease patients among one-level procedures compared with 2-level. Blood loss and operative time were lower in the MIS group. Length of hospital stay in the MIS cohort was shorter compared with the open cohort. There were 3 deep wound infections in the open cohort. ODI and VAS (leg and back) scores improved in both groups at 1 year compared with preoperative scores and did not differ between MIS and open cohorts. Fusion rate was similar for both groups (91% overall). One-level procedures and BMP use were associated with higher fusion rate, regardless of approach.

Conclusions:

MIS TLIF produces comparable clinical and radiologic outcomes to open TLIF with the benefits of decreased intraoperative blood losses, shorter operative times, shorter hospital stays, and fewer deep wound infections.

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