Clinical Effect Of Modified Minimally Invasive Transforaminal Lumbar Interbody Fusion Through Small Surgical Incision

Purpose:The transforaminal lumbar interbody fusion (TLIF) represents an efficient surgical treatment in degenerative lumbar disease. Along with minimally invasive surgery got rapid development in spine surgery, all kinds of minimally invasive surgery techniques for TLIF have been applied in clinic and obtained satisfactory clinical effect. The purpose of this study was to compare the clinical outcomes of small incision mini-open TLIF(mo-TLIF) versus traditional open TLIF(open-TLIF) and minimally invasive TLIF(mis-TLIF) for the treatment of single level lumbar disorders.Methods:The authors performed a retrospective review of 95 individuals with degenerative disc disease who underwent an one-level TLIF from October 2012 to October 2014. There were 35 patients underwent open-TLIF,29 patients underwent mis-TLIF and 31 patients underwent mo-TLIF. There has no obvious statistical differences in age, proportion of gender, disease type, lesion level, disease duration, preoperative VAS and ODI scores between three groups (P>0.05). The incision lengths, totally operation duration time, intraoperative radiological exposure times, intra-operative and post-operative blood loss, postoperative hospitalization times, perioperative complications, postoperative VAS and ODI scores were compared between three groups. We assessd the the locations of internal fixation and Cage and bone graft fusion through the imaging examination.Results:All patients of the three groups were followed-up from 6 to 36 months, with an average of 16.2 months. Except for 1 patients with postoperative infection in open-TLIF group, no complications such as nerve root injuries, rupture of dural matter, cerebrospinal fluid leakage, pedicle screw misplacement and surgical site infection had happened.The intra-operative and post-operative blood loss is less and postoperative hospitalization time is shorter in mo-TLIF group than in open-TLIF group, The VAS scores and ODI of mo-TLIF group and open-TLIF group at each stage after operation were remarkably improved when contrasted with those of pre-operation. The VAS scores and ODI of the mo-TLIF group was remarkably inferior than open-TLIF group at 3 days,1 weeks,1 months,3 months after operation. And There was no significant difference at 6 months,1 years and 2 years after operation. Length of incision in mo-TLIF group was longer than that in mis-TLIF, but operation time and times of X-ray exposure in mo-TLIF group were shorter than those in mis-TLIF. There had no statistical differences between three groups in intraoperative and postoperative blood losses, hospitalization duration after operation, VAS and ODI scores. The imageological examination revealed both high bone fusion rate and satisfactory positions of the screw rod system and Cage in three groups.Conclusions:Mo-TLIF could obtain satisfied short-term effects for degenerative lumbar disease patients, which not only provides similar surgical exposure as open-TLIF, but also has the same minimally invasive advantages as mis-TLIF. Mo-TLIF operation is practical and easy to promote, because it has a shorter learning curve and only need simple retractor instrument compare to minimally invasive expansion tube system.