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Clinical and Radiological Outcomes of Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion

Peng, Chan Wearn Benedict MD; Yue, Wai Mun MD; Poh, Seng Yew MD; Yeo, William Mphyty; Tan, Seang Beng MD

doi: 10.1097/BRS.0b013e3181a4e3be
Clinical Case Series

Study Design. Prospective study.

Objective. Comparison of clinical and radiologic outcomes of minimally invasive (MIS) versus Open transforaminal lumbar interbody fusion (TLIF).

Summary of Background Data. Open TLIF has been performed for many years with good results. MIS TLIF techniques have recently been introduced with the aim of smaller wounds and faster recovery.

Methods. From 2004–2006, 29 MIS TLIF were matched paired with 29 Open TLIF. Patient demographics and operative data were collected. Clinical assessment in terms of North American Spine Society, Oswestry Disability Index, Short Form-36, and Visual Analogue scores were performed before surgery, 6 months and 2 years after surgery. Fusion rates based on Bridwell grading were assessed at 2 years.

Results. The mean age for MIS and Open procedures were 54.1 and 52.5 years, respectively. There were 24 females and 5 males in both groups. Fluoroscopic time (MIS: 105.5 seconds, Open: 35.2 seconds, P < 0.05) and operative time (MIS: 216.4 minutes, Open: 170.5 minutes, P < 0.05) were longer in MIS cases. There was less blood loss in MIS (150 mL) versus Open (681 mL) procedures (P < 0.05). The total morphine used for MIS cases (17.4 mg) was less compared to Open (35.7 mg, P < 0.05). MIS (4 days) patients have shorter hospitalization compared to Open (6.7 days, P < 0.05). Both MIS and Open groups showed significant improvement in Oswestry Disability Index (P < 0.05), back pain and lower limb symptoms (North American Spine Society and Visual Analogue scores, P < 0.05), and Quality of Life scores (Short Form-36, P < 0.05) at 6 months and 2 years, but there was no significant difference between the 2 groups. Eighty percent of MIS and 86.7% of Open TLIF levels achieved grade 1 fusion (P > 0.05).

Conclusion. MIS TLIF has similar good long-term clinical outcomes and high fusion rates of Open TLIF with the additional benefits of less initial postoperative pain, early rehabilitation, shorter hospitalization, and fewer complications.

MIS TLIF has similar clinical outcomes and fusion rates when compared to the Open procedure. Its benefits over Open TLIF include less blood loss, less analgesic use, shorter hospitalization, and fewer complications.

From the Singapore General Hospital, Outram Road, Singapore.

Acknowledgment date: September 4, 2008. First revision date: December 1, 2008. Second revision date: January 1, 2009. Acceptance: January 8, 2009.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

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 Wai Mun Yue, MD, Department of Orthopedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.