Clinical and radiographic comparison of mini–open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up

Clinical article

Sanjay S. DhallDepartment of Neurosurgery, University of California, San Francisco, California;
Department of Neurosurgery, Emory University, Atlanta, Georgia

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Michael Y. WangUniversity of Miami, Department of Neurosurgery, Miami, Florida; and

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Praveen V. MummaneniDepartment of Neurosurgery, University of California, San Francisco, California;

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Page Range:
560–565
Volume/Issue:
Volume 9: Issue 6
DOI link:
https://doi.org/10.3171/SPI.2008.9.08142
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Object

As minimally invasive approaches gain popularity in spine surgery, clinical outcomes and effectiveness of mini–open transforaminal lumbar interbody fusion (TLIF) compared with traditional open TLIF have yet to be established. The authors retrospectively compared the outcomes of patients who underwent mini–open TLIF with those who underwent open TLIF.

Methods

Between 2003 and 2006, 42 patients underwent TLIF for degenerative disc disease or spondylolisthesis; 21 patients underwent mini–open TLIF and 21 patients underwent open TLIF. The mean age in each group was 53 years, and there was no statistically significant difference in age between the groups (p = 0.98). Data were collected perioperatively. In addition, complications, length of stay (LOS), fusion rate, and modified Prolo Scale (mPS) scores were recorded at routine intervals.

Results

No patient was lost to follow-up. The mean follow-up was 24 months for the mini-open group and 34 months for the open group. The mean estimated blood loss was 194 ml for the mini-open group and 505 ml for the open group (p < 0.01). The mean LOS was 3 days for the mini-open group and 5.5 days for the open group (p < 0.01). The mean mPS score improved from 11 to 19 in the mini-open group and from 10 to 18 in the open group; there was no statistically significant difference in mPS score improvement between the groups (p = 0.19). In the mini-open group there were 2 cases of transient L-5 sensory loss, 1 case of a misplaced screw that required revision, and 1 case of cage migration that required revision. In the open group there was 1 case of radiculitis as well as 1 case of a misplaced screw that required revision. One patient in the mini-open group developed a pseudarthrosis that required reoperation, and all patients in the open group exhibited fusion.

Conclusions

Mini–open TLIF is a viable alternative to traditional open TLIF with significantly reduced estimated blood loss and LOS. However, the authors found a higher incidence of hardware-associated complications with the mini–open TLIF.

Abbreviations used in this paper:

DDD = degenerative disc disease; EBL = estimated blood loss; ICBG = iliac crest bone graft; LIF = lumbar interbody fusion; LOS = length of stay; mPS = modified Prolo Scale; rhBMP = recombinant human bone morphogenetic protein; TLIF = transforaminal LIF.
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Contributor Notes

Address correspondence to: Praveen V. Mummaneni, M.D., Department of Neurosurgery, 505 Parnassus Avenue, M-779, Box 0112, San Francisco, California 94143. email: vmum@aol.com.
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