Perioperative Safety and Efficacy of Multilevel Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison with Conventional Open Surgery

Sang Hyuk Min; Jae Sung Yoo; Sung Hyun Yoon; Chul Woo Rhee

doi:10.4055/jkoa.2012.47.6.416

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Min, Yoo, Yoon, and Rhee: Perioperative Safety and Efficacy of Multilevel Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison with Conventional Open Surgery

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(6): 416-424.

Published online: 28 December 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.6.416

Perioperative Safety and Efficacy of Multilevel Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison with Conventional Open Surgery

Sang Hyuk Min, M.D., Jae Sung Yoo, M.D., Sung Hyun Yoon, M.D., Chul Woo Rhee, M.D.^*

Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University Medical College, Cheonan, Korea.

^*Department of Preventive Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Correspondence to: Sang Hyuk Min, M.D. Department of Orthopaedic Surgery, Dankook University Hospital, 201, Manghyang-ro, Dongnam-gu, Cheonan 330-715, Korea. TEL: +82-41-550-3950, FAX: +82-41-550-7161, osmin71@naver.com

Received 5 July 2012 Revised 30 October 2012 Accepted 22 November 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was aimed to examine the ways to reduce bleeding through minimally invasive multi-segmental fusion by comparing the results of minimally invasive transforaminal lumbar interbody fusion versus those of conventional posterior interbody fusion depending on the number of fused segment. Moreover, the study identified how the new method of fusion contributed to reducing postoperative complications and to fast recovery.

Materials and Methods

This is a retrospective study conducted on 367 spinal stenosis patients who had been followed up for at least one year (170 patients underwent minimally invasive transforaminal lumbar interbody fusion and 197 patients underwent conventional posterior interbody fusion). The study examined blood loss volume, postoperative drainage volume, operation time, visual analogue scale score, pre- and post-operative levels of protein and albumin, as well as postoperative bed rest period between the two groups. Moreover, the study analyzed the presence of complications during the peri-operative period.

Results

The minimally invasive fusion group exhibited a statistically significant decrease in intraoperative bleeding than the conventional infusion group when the number of fused segments in each group was compared. In addition, the difference in the two groups showed a statistically significant increase as the numbers of fused segments rose (p<0.05). On the other hand, a statistically significant increase was shown in the operation time between the minimally invasive fusion group and the conventional fusion group. The difference in the two groups showed a statistically significant increase as the distance of fused segments was extended (p<0.05).

Conclusion

Minimally invasive transforaminal lumbar interbody fusion is thought to be a useful surgical method to minimize bleeding when the limitations of minimal invasive fusion are supplemented by shortening the operation time.

Keywords: multi-level fusion, minimal invasive surgery, complications

Figures and Tables

Figure 1

Multilevel MI-TLIF procedure. (A) Preoperative radiography. (B) Postoperative radiography. MI-TLIF, minimally invasive transforaminal lumbar interbody fusion.

Figure 2

Comparison of intraoperative blood loss between MI-TLIF and Open surgery stratified by level. Minimal, minimally invasive transforaminal lumbar interbody fusion (MI-TLIF); Open, conventional open surgery.

Figure 3

Comparison of surgical time between MI-TLIF and Open surgery stratified by level. Minimal, minimally invasive transforaminal lumbar interbody fusion (MI-TLIF); Open, conventional open surgery.

Table 1

Patients Data

MI-TLIF, minimally invasive transforaminal lumbar interbody fusion; Open, conventional open surgery; M, male; F, female.

Table 2

Comparison of Operation Profile between MI-TLIF and Open Stratified by Level

Values are presented as mean±standard deviation. MI-TLIF, minimally invasive transforaminal lumbar interbody fusion; Open, conventional open surgery; VAS, visual analogue scale score; pre-op, preoperative; post-op, postoperative.

Table 3

Comparison of Complication Incidences between MI-TLIF and Open Stratified by Level

MI-TLIF, minimally invasive transforaminal lumbar interbody fusion; Open, conventional open surgery.

Table 4

Comparison of Complication Incidences between MI-TLIF and Open

MI-TLIF, minimally invasive transforaminal lumbar interbody fusion; Open, conventional open surgery; RDS, respiratory distress syndrome; UTI, urinary tract infection; ARF, acute renal failure.

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