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Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Review of Techniques and Outcomes

Karikari, Isaac O. MD; Isaacs, Robert E. MD

doi: 10.1097/BRS.0b013e3182022ddc
Surgery

Study Design. Review of published literature.

Objective. To review the available medical literature reporting results after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) and evaluate functional and radiographic outcomes with those following open TLIF and open posterior lumbar interbody fusion (PLIF) procedures.

Summary of Background Data. Minimally invasive spine techniques aim to reduce approach-related surgical morbidity without compromising operative and clinical outcomes. MIS TLIF is increasingly being used for the management of various lumbar degenerative diseases. Despite the limited number of well-designed clinical studies, the available published data suggest potential advantages over its open posterior-approach lumbar interbody fusion counterparts. Such benefits include less intraoperative blood loss, less need for blood transfusions, shorter hospital course, and less postoperative pain.

Methods. Literature examining posterior-approach interbody fusion techniques (PLIF, TLIF, and MIS TLIF) was collected using the National Center for Biotechnology Information database and PubMed/MEDLINE, and summarized for discussion.

Results. Literature reports of MIS TLIF generally show comparable or improved clinical outcomes when compared with those following open posterior interbody fusion techniques. Additionally, significantly less blood loss, hospital stay, and complications were generally reported, despite slightly longer duration of surgery, especially during early cases in a surgeon's experience.

Conclusion. More studies designed to provide class I or II data will be needed in the future to further solidify the favorable results observed so far with the MIS TLIF procedure.

Minimally invasive transforaminal lumbar interbody fusion procedure is increasingly being used for the management of various lumbar degenerative diseases. Minimally invasive transforaminal lumbar interbody fusion has significant benefits such as less intraoperative blood loss and postoperative pain. However, more studies are needed to further elucidate its potential clinical benefits.

From the Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC.

Acknowledgment date: August 20, 2010. First revision date: September 27, 2010. Second revision date: October 14, 2010. Acceptance date: October 15, 2010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Robert E. Isaacs, MD, Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, Durham, NC 27710; E-mail: robert.isaacs@duke.edu

© 2010 Lippincott Williams & Wilkins, Inc.