Minimally Invasive Transforaminal Lumbar Interbody Fusion Using a Single Interbody Cage and a Tubular Retraction System : Technical Tips, and Perioperative, Radiologic and Clinical Outcomes.

Lee, Chang Kyu; Park, Jeong Yoon; Zhang, Ho Yeol

doi:2010.48.3.219

Original Article

Journal of Korean Neurosurgical Society 2010;48(3): 219-224.
doi: https://doi.org/10.3340/jkns.2010.48.3.219

Minimally Invasive Transforaminal Lumbar Interbody Fusion Using a Single Interbody Cage and a Tubular Retraction System : Technical Tips, and Perioperative, Radiologic and Clinical Outcomes.

Chang Kyu Lee, Jeong Yoon Park, Ho Yeol Zhang

¹Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea.
²Department of Neurosurgery, National Health Insurance Corporation Ilsan Hospital, Yonsei University College of Medicine, Goyang, Korea. spinepjy@nhimc.or.kr

ABSTRACT

OBJECTIVE
A minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has recently been introduced. However, MIS TLIF is a technically challenging procedure. The authors performed retrospective analysis about MIS TLIF using a single interbody cage.
METHODS
Twenty-eight consecutive patients were treated by MIS TLIF. Of these 28 patients, 20 patients were included in this retrospective study. Perioperative, clinical, and radiologic outcomes were assessed. Clinical outcomes were assessed using Oswestry Disability Index (ODI) and Visual Analogue Scores (VAS). Fusion rates and cross-sections of operated spinal canals were assessed by CT.
RESULTS
Twelve patients underwent MIS TLIF at one segment and 8 patients at two segments (L3/4: 4, L4/5: 17, L5/S1: 7). Operation time for a single segment was 131.7 min and for two segment was 201.4 min, and corresponding blood losses were 208.3 mL and 481.2 mL, respectively. ODI and VAS scores were significantly improved at 6 months postop (ODI from 30.32 to 15. 54, VAS from 7.80 to 2.20, p = 0.001). Twenty-two segments (78.6%) achieved grade I fusion, 4 segments (14.3%) achieved grade II, 2 segments (7.1%) achieved grade III and 0 segments achieved grade IV at 12 months. Postoperatively at 12 months, spinal canal cross sectional areas at disc spaces significantly increased from 157.5 to 294.3 mm2 (p = 0.012).
CONCLUSION
MIS TLIF achieved good clinical outcomes and high fusion rates. Our findings show that MIS TLIF performed with a single interbody cage and a tubular retractor system can be used as a standard MIS TLIF technique.

Key Words: Minimally invasive; Spinal fusion; Lumbar vertebrae