Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Two Techniques
G. C. Tender, D. SerbanOriginal article, no. 6, 2014
Background: Minimally invasive transforaminal lumbar interbodyfusion (MI TLIF) is very popular in the United States.Two techniques are commonly used, based on either tubularor pedicle-screw-based retraction.Materials and Methods: Sixty patients underwent MI TLIFbetween 2009 and 2012, using the tubular technique (43patients) or screw-based-retractor technique (17 patients).Perioperative parameters and 1-year outcomes were reviewed.Results: For the tubular technique, the average operative time,blood loss, and hospital stay were 189 min, 170 ml, and 3.37days, respectively. The visual analog scale (VAS) score improvedfrom 9.7 preoperatively to 2.6 at 1-year postoperatively. Therewere two incidental durotomies, none resulting in a CSF leak.There was one re-intervention for removal of a misplacedpedicle screw. For the screw-based-retractor technique, theaverage operative time, blood loss, and hospital stay were 223min, 257 ml, and 3.29 days, respectively. VAS improved from9.4 to 1.9. One patient who had an incidental durotomydeveloped a postoperative compressive hematoma with resultant cauda equina syndrome requiring re-intervention.There were no re-interventions for revision of instrumentation.Seven patients were lost at the 1-year visit. The fusion rateat 1-year was 100%.Conclusion: Both techniques can be used with good results,but each technique offers distinct advantages and challengesthat can be tailored to individual patients.
