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Comparative Analysis of Two Transforaminal Lumbar Interbody Fusion Techniques

Open TLIF Versus Wiltse MIS TLIF

Ge, David H., BA; Stekas, Nicholas D., BS; Varlotta, Christopher G., BS; Fischer, Charla R., MD; Petrizzo, Anthony, DO; Protopsaltis, Themistocles S., MD; Passias, Peter G., MD; Errico, Thomas J., MD; Buckland, Aaron J., MD

doi: 10.1097/BRS.0000000000002903

Study Design. A retrospective cohort study at a single institution.

Objective. The aim of this study was to analyze the perioperative and postoperative outcomes of patients who underwent open transforaminal lumbar interbody fusion (O-TLIF) and bilateral minimally invasive surgery (MIS) Wiltse approach TLIF (Wil-TLIF).

Summary of Background Data. Several studies have compared open TLIF to MIS TLIF; however, comparing the techniques using a large cohort of one-level TLIFs has not been fully explored.

Methods. We reviewed the charts of patients undergoing a single-level primary posterior lumbar interbody fusion between 2012 and 2017. The cases were categorized as Open TLIF (traditional midline exposure including lateral exposure of transverse processes) or bilateral paramedian Wiltse TLIF approach. Differences between groups were assessed by t tests.

Results. Two hundred twenty-seven patients underwent one-level primary TLIF (116 O-TLIF, 111 Wil-TLIF). There was no difference in age, gender, American Society of Anesthesiologists (ASA), or body mass index (BMI) between groups. Wil-TLIF had the lowest estimated blood loss (EBL; 197 vs. 499 mL O-TLIF, P ≤ 0.001), length of stay (LOS; 2.7 vs. 3.6 days O-TLIF, P ≤ 0.001), overall complication rate (12% vs. 24% O-TLIF, P = 0.015), minor complication rate (7% vs. 16% O-TLIF, P = 0.049), and 90-day readmission rate (1% vs. 8% O-TLIF, P = 0.012). Wil-TLIF was associated with the higher fluoroscopy time (83 vs. 24 seconds O-TLIF, P ≤ 0.001). There was not a significant difference in operative time, intraoperative or neurological complications, extubation time, reoperation rate, or infection rate.

Conclusion. In comparing Wiltse MIS TLIF to Open TLIF, the minimally invasive paramedian Wiltse approach demonstrated the lowest EBL, LOS, readmission rates, and complications, but longer fluoroscopy times when compared with the traditional open approach.

Level of Evidence: 3

227 single-level TLIFs were categorized as Open TLIF or bilateral paramedian Wiltse TLIF approach. Wiltse approach TLIF demonstrated the lowest EBL, LOS, complication rate, and readmission rate when compared to traditional open approach, but longer fluoroscopy times.

Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY.

Address correspondence and reprint requests to Aaron J. Buckland, MD, Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th St. Suite 400, New York, NY 10003; E-mail:

Received 25 May, 2018

Revised 24 August, 2018

Accepted 14 September, 2018

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

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.