scholarly journals Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications

2006 ◽  
Vol 20 (3) ◽  
pp. 1-5 ◽  
Author(s):  
Langston T. Holly ◽  
James D. Schwender ◽  
David P. Rouben ◽  
Kevin T. Foley
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Radicular Pain ◽  
Low Back ◽  
Lumbar Interbody Fusion ◽  
Disc Disease ◽  
Dorsal Approach ◽  
Tubular Retractor

✓The authors provide an overview of the minimally invasive transforaminal lumbar interbody fusion (TLIF) procedure including indications, technique, and complications. This novel technique is a method of achieving circumferential lumbar fusion using a unilateral dorsal approach. Minimally invasive TLIF uses a tubular retractor that is inserted via a muscle-dilating exposure, thereby minimizing the approach-related morbidity. This procedure is ideal for refractory mechanical low-back and radicular pain associated with spondylolisthesis, degenerative disc disease, and recurrent disc herniation. The authors' clinical experience and review of the medical literature indicate that TLIF can be effectively and safely performed in a minimally invasive fashion.

scholarly journals Clinical outcomes of minimally invasive transforaminal lumbar interbody fusion via a novel tubular retractor

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092009
Author(s):  
Yan Wang ◽  
Yaqing Zhang ◽  
Fanli Chong ◽  
Yue Zhou ◽  
Bo Huang
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Fatty Infiltration ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Cerebrospinal Fluid Leakage ◽  
Lumbar Interbody Fusion ◽  
Multifidus Muscle ◽  
Tubular Retractor ◽  
Estimated Blood Loss

Objective To assess the feasibility and clinical results of microscopic minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using a novel tapered tubular retractor that preserves the multifidus. Method A total of 122 patients underwent MIS-TLIF using a tapered tubular retractor system from March 2016 to August 2017. Perioperative parameters and follow-up outcomes were reviewed. Results The follow-up period was 23.95 ± 1.43 months. The operative time averaged 130.48 ± 34.44 minutes. The estimated blood loss was 114.10 ± 96.70 mL. The mean time until ambulation was 16.33 ± 6.29 hours. The average visual analogue scale (leg/waist) and Oswestry Disability Index scores (preoperative to last follow-up) improved from 4.93 ± 2.68/3.74 ± 2.28 to 0.34 ± 0.77/0.64 ± 0.74 and from 59.09% ± 22.34 to 17.04% ± 8.49, respectively. At the last follow-up, 98.36% of the patients achieved solid fusion. Cerebrospinal fluid leakage occurred in two cases. The asymptote of the surgeon’s learning curve occurred at the 25th case. There were no significant differences between the preoperative qualitative and quantitative analyses of multifidus muscle fatty infiltration and those at the final follow-up. Conclusion MIS-TLIF can be performed safely and effectively using this tapered tubular retractor system, which helps preserve the multifidus.

scholarly journals Full-Endoscopic Lumbar Fusion Outcomes in Patients with Minimal Deformities: A Retrospective Study of Data Collected Between 2011 and 2015

2019 ◽  
Vol 1 (22;1) ◽  
pp. 75-88 ◽  
Author(s):  
Solomon Kamson
Keyword(s):  
Back Pain ◽  
Blood Loss ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Disc Disease ◽  
Patient Reported ◽  
Clinical Series ◽  
Global Sagittal Alignment

Background: Open transforaminal lumbar interbody fusion (TLIF) is the gold standard treatment for back pain due to degenerative disc disease and lumbar instability. Traditional open TLIF has been associated with extensive tissue dissection, excessive blood loss, and slow recovery time. Full-endoscopic transforaminal lumbar interbody fusion (FE-TLIF) is an evolving treatment. Objectives: This study aims to review outcomes of FE-TLIF performed in an ambulatory surgery center (ASC) on patients with advanced disc disease with minimal spinal deformity. Study Design: This study employed a retrospective cohort design. Methods: This Western Institutional Review Board-approved study (#1-925640-1) assessed blood loss, operative time (OR time), post anesthesia care unit time (PACU time), and Visual Analog Scale (VAS) of 85 patients who underwent FE-TLIF between 2011 and 2015 and were followed up for 12 months. Relationships between risk factors (demographics, clinical presentation) and outcomes were analyzed. Results: No intraoperative complications were observed. There were 2 cases of postoperative sympathetically mediated pain and 3 reoperations. The number of decompression/fusion levels was crucial to OR time but had a smaller impact on PACU time. OR time for patients with 2-level fusion was 110 minutes longer than for those with one level operation. BMI and age had no significant effect on OR time. BMI had a modest effect on PACU time. Gender and age did not affect PACU time. A significant decrease in VAS was observed. Limitations: This study has several limitations, including the lack of a control group and reliance on patient-reported outcomes (VAS). In addition, fusion rate and global sagittal alignment were not measured. Although not statistically significant, the use of facet screws, unilateral, or bilateral pedicle screws presented variation in techniques within the group. Early recovery also diminished the incentive for long-term follow-up. Conclusion: FE-TLIF is a feasible technique for lumbar stabilization surgery in an ASC in select patients. This level-II study demonstrates safety in a variety of clinical presentations, including obesity, extremes of age, and anatomical access challenge. Larger clinical series are necessary to validate this technique, particularly for the treatment of patients with advanced spinal deformities. Key words: Full-endoscopic, minimally invasive spine surgery, postoperative complications, TLIF, lumbar fusion, low back pain

scholarly journals Minimally Invasive Transforaminal Lumbar Interbody Fusion Ameliorates Persistent Pain After Lumbar Fusion Surgery

2020 ◽  
Author(s):  
Jun Li ◽  
Kai Liu ◽  
Li Yang ◽  
DEGUO WANG
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Persistent Pain ◽  
Lumbar Interbody Fusion ◽  
Fusion Surgery ◽  
Drainage Fluid ◽  
Lumbar Fusion Surgery ◽  
Degenerative Lumbar Diseases

Abstract Background: Approximately 4-20% patients with degenerative lumbar diseases showed persistent pain after lumbar fusion surgery that may develop into failed back surgery syndrome (FBSS), and this persistent pain may be related to the postoperative increased release of inflammatory mediators. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) can obviously reduce the intraoperative soft tissue trauma. The aim of this study is to investigate the persistent pain in the patients with degenerative lumbar diseases undergoing MIS-TLIF compared with conventional‑invasive TLIF. Material and methods: This study retrospectively included 146 patients (MIS-TLIF vs. conventional‑invasive TLIF: 56 vs. 90), and the incidence of persistent pain were evaluated. Furthermore, inflammation related markers in both blood and drainage fluid samples, including white blood cell (WBC) count, C-reactive protein (CRP), creatine kinase (CK), interleukin-6 (IL-6) and IL-1β, were tested before and after operation. Results: Significantly larger number of patients undergoing conventional‑invasive TLIF showed postoperative persistent pain compared to those undergoing MIS-TLIF (4/56, 7.1% vs. 20/90, 22.2%; P < 0.05). In both treatment groups, the patients with postoperative persistent pain showed increased IL-6 and IL-1β in drainage fluid, as well as increased IL-6 in blood samples (P < 0.05), and there is significant correlation between the inflammation markers in drainage fluid and the extent of postoperative persistent pain in patients with postoperative persistent pain (P < 0.05). Conclusions: Local inflammatory substance accumulation may be potential cause for postoperative persistent pain, and MIS-TLIF may reduce this inflammatory accumulation at the surgical site and subsequently reduce the risk of persistent pain.

scholarly journals Mini-open transforaminal lumbar interbody fusion

2013 ◽  
Vol 35 (v2supplement) ◽  
pp. Video2 ◽  
Author(s):  
Beejal Y. Amin ◽  
Tsung-Hsi Tu ◽  
Praveen V. Mummaneni
Keyword(s):  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Patient Positioning ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Percutaneous Technique ◽  
Lumbar Interbody Fusion ◽  
Open Technique ◽  
Tubular Retractor ◽  
Key Steps ◽  
Mini Open

The potential advantages of a mini-open transforaminal interbody fusion (TLIF) operation are reduced blood loss, shorter length of stay, and less soft-tissue trauma compared to the standard open technique. Prior reports from our group and others have demonstrated successful outcomes using MIS techniques in lumbar fusion surgery.In this 3D video, we demonstrate the key steps of the mini-open technique for a transforaminal lumbar interbody fusion using an expandable tubular retractor and contralateral percutaneous screw fixation for the treatment of a multiple recurrent disc herniation. The video demonstrates patient positioning, surgical opening with development of the Wiltse plane, placement of the tubular retractor, pedicle screw placement through both a percutaneous technique and a mini-open technique, decompression of the neural elements, graft insertion, and wound closure.The video can be found here: http://youtu.be/LYRU9lbBdNg.

scholarly journals MICROSURGICAL LANDMARKS IN MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION

2015 ◽  
Vol 14 (4) ◽  
pp. 317-319 ◽  
Author(s):  
Javier Quillo-Olvera ◽  
Sergio Soriano-Solis ◽  
Ramses Uriel Ortiz-Leyva ◽  
Carlos Francisco Gutiérrez-Partida ◽  
Manuel Rodríguez-García ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Facet Joint ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Lumbar Interbody Fusion ◽  
Anatomical Models ◽  
Tubular Retractor ◽  
Surgical Field

Microsurgical landmarks of the facet joint complex were defined to provide guidance and security within the tubular retractor during transforaminal surgery. A retrospective observational study was performed in segments L4-L5 by the left side approach. Microsurgical relevant photos, anatomical models and drawing were used to expose the suggested landmarks. The MI-TLIF technique has advantages compared with conventional open TLIF technique, however minimally invasive technique implies lack of security for the surgeon due to the lack of defined microanatomical landmarks compared to open spine surgery, and disorientation within the tubular retractor, the reason why to have precise microsurgical references and its recognition within the surgical field provide speed and safety when performing minimally invasive technique.

scholarly journals COMPLICATIONS IN THREE LUMBAR ARTHRODESIS TECHNIQUES: TLIF, MITLIF, PLIF

2017 ◽  
Vol 16 (1) ◽  
pp. 74-77 ◽  
Author(s):  
AVELINO AGUILAR MERLO ◽  
RICARDO ROJAS BECERRIL ◽  
MARIO LORETO LUCAS ◽  
SHEILA PATRICIA VÁZQUEZ ARTEAGA
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Spine Surgeon ◽  
Lumbar Spondylolisthesis ◽  
Incidental Durotomy ◽  
Invasive Techniques

ABSTRACT Objective: To determine that minimally invasive transforaminal lumbar fusion has fewer complications of chronic lumbar instability compared with traditional open techniques. Methods: Retrospective, observational study of 132 patients with grade I and II lumbar spondylolisthesis with advanced disc degeneration. Forty-five patients operated by minimally invasive transforaminal lumbar interbody fusion (MITLIF), 45 patients operated by posterior lumbar interbody fusion (PLIF) and 42 patients operated by open transforaminal lumbar interbody fusion (TLIF). Results: Four patients had incidental durotomy, two in the TLIF group and two in the PLIF group. There were no cases of incidental durotomy in the minimally invasive transforaminal access group. No patient in the study presented an inadequate screw position, the lowest mean bleeding occurred in the group of minimally invasive instrumentation of one and two levels. There were 6.6% of infections for PLIF group and none in the other two groups. Conclusions: Arthrodesis techniques are not free of complications, however, the frequency is lower with minimally invasive techniques. Nonetheless, it requires training and does not dispense the need for a learning curve for the spine surgeon compared to open lumbar fusion techniques.

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