Mast Quadrant-assisted minimally invasive modified transforaminal lumbar interbody fusion: single incision versus double incision

A novel mini-open transforaminal lumbar interbody fusion for lumbar degenerative diseases: technical note and preliminary results

BACKGROUND

Transforaminal lumbar interbody fusion (TLIF) is an effective and popular surgical procedure for the management of various spinal pathologies, especially degenerative diseases. Surgeons have been pursuing minimally invasive technology as soon as TLIF was appeared. Currently, TLIF can be performed with transforaminal approaches by open surgery, minimally invasive surgery or percutaneous endoscope. We provide a detailed description of a new modified open TLIF with percutaneous pedicle screws, which we refer to as mini-open TLIF. The objective of this study was to present feasibility of this procedure and the preliminary results.

METHODS

The study is a prospective study. From January 2021 to March 2022, 96 patients (43 males and 53 females) with neurological symptoms due to degenerative lumbar spine diseases were enrolled. Operation time, blood loss, ambulatory time, hematocrit and complications were recorded during perioperative period. Clinical symptoms were evaluated 1 week, 3 months and 12 months after surgery. Visual analogue scale (VAS) scores for lower back pain and leg pain and Oswestry disability index (ODI) were assessed. Magnetic resonance imaging was performed preoperatively and 12 months postoperatively to emulate cross-sectional area of paraspinal muscles. The lumbar interbody fusion rate was evaluated by CT scanning.

RESULTS

The mean operation time of single level was 112.6 min, and the mean operation time of multilevel was 140.1 min. Intraoperative blood loss of single level was 64.5 ml and was 116.3 ml of multilevel. The VAS and ODI scores before and after surgery were significantly different (P < 0.0001) and reached minimal clinically important difference. Atrophy rate of paraspinal muscles was 2.5% for symptomatic side and 1.2% for asymptomatic side. The cross-sectional area before and after the operation and atrophy rate had no statistically significant difference (P > 0.05).

CONCLUSION

Mini-open TLIF is effective and feasible for the treatment of lumbar degenerative diseases especially in multilevel disease, with minor damage to muscle and shorter operation time.

TRIAL REGISTRATION

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Second Affiliated Hospital of Soochow University (No. JD-LK2023045-I01).

Clinical Efficacy Study of the Quadrant Channel and Delta Large Channel Technique in the Treatment of Lumbar Degenerative Diseases

Objective

To compare the therapeutic effect of the quadrant channel and delta large channel techniques in lumbar degenerative diseases.

Methods

According to the inclusion criteria, 62 patients suffering from lumbar degenerative disease were selected for the present study, which was conducted from September 2018 to June 2020. Patients were divided into Group A (quadrant channel technology) and Group B (delta large channel technology), which comprised 28 and 34 patients, respectively. The factors compared between the two groups were operation time, length of incision, blood loss, ambulation time, length of hospitalization, visual analogue scale (VAS) preoperatively, 7 days postoperatively, and 30 days postoperatively, and Oswestry dysfunction score (ODI).

Results

The length of incision, blood loss, ambulation time, and length of hospitalization stay in Group A were significantly higher compared with Group B (P < 0.05). There was no significant difference between the two groups in operation time, preoperative ODI index, preoperative VAS scores, and thirty-day postoperative VAS scores (P > 0.05). The seven-day postoperative VAS score, seven-day postoperative ODI index, and thirty-day postoperative ODI index of Group A were significantly higher than those of Group B (P < 0.05). The preoperative VAS score and ODI index in both groups were significantly higher compared with after operation (P < 0.05).

Conclusion

Both surgical methods achieved a good clinical outcome in the treatment of lumbar degenerative diseases. The delta large channel technique may offer some advantages over quadrant channel technology, such as less trauma and bleeding and faster recovery time.

Defining the MIS-TLIF: A Systematic Review of Techniques and Technologies Used by Surgeons Worldwide

STUDY DESIGN

Systematic review.

OBJECTIVE

To date there is no consensus among surgeons as to what defines an MIS-TLIF (transforaminal lumbar interbody fusion using minimally invasive spine surgery) compared to an open or mini-open TLIF. This systematic review aimed to examine the MIS-TLIF techniques reported in the recent body of literature to help provide a definition of what constitutes the MIS-TLIF, based on the consensus of the majority of surgeons.

METHODS

We created a database of articles published about MIS-TLIF between 2010 and 2018. We evaluated the technical components of the MIS-TLIF including instruments and incisions used as well the order in which key steps are performed.

RESULTS

We could identify several patterns for MIS-TLIF performance that seemed agreed upon by the majority of MIS surgeons: use of paramedian incisions; use of a tubular retractor to perform a total facetectomy, decompression, and interbody cage implantation; and percutaneous insertion of the pedicle-screw rod constructs with intraoperative imaging.

CONCLUSION

Based on this review of the literature, the key features used by surgeons performing MIS TLIF include the use of nonexpandable or expandable tubular retractors, a paramedian or lateral incision, and the use of a microscope or endoscope for visualization. Approaches using expandable nontubular retractors, those that require extensive subperiosteal dissection from the midline laterally, or specular-based retractors with wide pedicle to pedicle exposure are far less likely to be promoted as an MIS-based approach. A definition is necessary to improve the communication among spine surgeons in research as well as patient education.

Clinical outcomes after minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion for treatment of degenerative lumbar disease: a systematic review and meta-analysis

The surgical procedures used for arthrodesis in the lumbar spine for degenerative lumbar diseases remain controversial. This systematic review aims to assess and compare clinical outcomes along with the complications and fusion of each technique (minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) or minimally invasive lateral lumbar interbody fusion (MIS LLIF)) for treatment of degenerative lumbar diseases. Relevant studies were identified from Medline and Scopus from inception to July 19, 2016 that reported Oswestry Disability Index (ODI), back and leg pain visual analog score (VAS), postoperative complications, and fusion of either technique. Fifty-eight studies were included for the analysis of MIS-TLIF; 40 studies were included for analysis of LLIF, and 1 randomized controlled trial (RCT) study was included for comparison of MIS-TLIF to LLIF. Overall, there were 9506 patients (5728 in the MIS-TLIF group and 3778 in the LLIF group). Indirect meta-analysis, MIS-TLIF provided better postoperative back and leg pain (VAS), disabilities (ODI), and risk of having complications when compared to LLIF technique, but the fusion rate was not significantly different between the two techniques. However, direct meta-analysis between RCT study and pooled indirect meta-analysis of MIS-TLIF have better pain, disabilities, and complication but no statistically significant difference when compared to LLIF. In LLIF, the pooled mean ODI and VAS back pain were 2.91 (95% CI 2.49, 3.33) and 23.24 (95% CI 18.96, 27.51) in MIS approach whereas 3.14 (95% CI 2.29, 4.04) and 28.29 (95% CI 21.92, 34.67) in traditional approach. In terms of complications and fusion rate, there was no difference in both groups. In lumbar interbody fusion, MIS-TLIF had better ODI, VAS pain, and complication rate when compared to LLIF with direct and indirect meta-analysis methods. However, in terms of fusion rates, there were no differences between the two techniques.

Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature

OBJECT Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and lateral lumbar interbody fusion (LLIF) are 2 currently popular techniques for lumbar arthrodesis. The authors compare the total risk of each procedure, along with other important complication outcomes. METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies (up to May 2015) that reported complications of either MI-TLIF or LLIF were identified from a search in the PubMed database. The primary outcome was overall risk of complication per patient. Secondary outcomes included risks of sensory deficits, temporary neurological deficit, permanent neurological deficit, intraoperative complications, medical complications, wound complications, hardware failure, subsidence, and reoperation. RESULTS Fifty-four studies were included for analysis of MI-TLIF, and 42 studies were included for analysis of LLIF. Overall, there were 9714 patients (5454 in the MI-TLIF group and 4260 in the LLIF group) with 13,230 levels fused (6040 in the MI-TLIF group and 7190 in the LLIF group). A total of 1045 complications in the MI-TLIF group and 1339 complications in the LLIF group were reported. The total complication rate per patient was 19.2% in the MI-TLIF group and 31.4% in the LLIF group (p < 0.0001). The rate of sensory deficits and temporary neurological deficits, and permanent neurological deficits was 20.16%, 2.22%, and 1.01% for MI-TLIF versus 27.08%, 9.40%, and 2.46% for LLIF, respectively (p < 0.0001, p < 0.0001, p = 0.002, respectively). Rates of intraoperative and wound complications were 3.57% and 1.63% for MI-TLIF compared with 1.93% and 0.80% for LLIF, respectively (p = 0.0003 and p = 0.034, respectively). No significant differences were noted for medical complications or reoperation. CONCLUSIONS While there was a higher overall complication rate with LLIF, MI-TLIF and LLIF both have acceptable complication profiles. LLIF had higher rates of sensory as well as temporary and permanent neurological symptoms, although rates of intraoperative and wound complications were less than MI-TLIF. Larger, prospective comparative studies are needed to confirm these findings as the current literature is of relative poor quality.