Impact of Iliac Crest Bone Grafting on Postoperative Outcomes and Complication Rates Following Minimally Invasive Transforaminal Lumbar Interbody Fusion

Object Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has the potential advantage of minimizing soft-tissue damage and reducing recovery time compared to open procedures. A steep learning curve has been described for the technique. The aim of the present study was to define the learning curve that describes the progress of a single surgeon performing the MI-TLIF. Methods One hundred fifty consecutive patients with degenerative lumbar disease who underwent 1- or 2-level MI-TLIF were included in the study. Operative time, corrected operative time per level, and complications were analyzed. The learning curve was assessed using a negative exponential curve-fit regression analysis. Results One hundred ten patients underwent 1-level and 18 patients underwent 2-level MI-TLIF; the remaining 22 underwent a single-level procedure plus an ancillary procedure (decompression at adjacent level, vertebral augmentation through fenestrated pedicle screws, interspinous device at adjacent level). Negative exponential curves appropriately described the relationship between operative time and experience for 1-level surgery and after correction of operative time per level (R2 = 0.65 and 0.57). The median operative time was 140 minutes (interquartile range 120–173 minutes), and a 50% learning milestone was achieved at Case 12; a 90% learning milestone was achieved at Case 39. No patient required transfusion in the perioperative period. The overall complication rate was 12.67% and the most frequent complication was a dural tear (5.32%). Before the 50% and 90% learning milestones, the complication rates were 33% and 20.51%, respectively. Conclusions The MI-TLIF is a reliable and effective option for lumbar arthrodesis. According to the present study, 90% of the learning curve can be achieved at around the 40th case.

Download Full-text

The Effect of Preoperative Symptom Duration on Postoperative Outcomes After Minimally Invasive Transforaminal Lumbar Interbody Fusion

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000881 ◽

2019 ◽

pp. 1

Author(s):

Joon S. Yoo ◽

Dillon S. Patel ◽

Nadia M. Hrynewycz ◽

Thomas S. Brundage ◽

Franchesca A. Mogilevsky ◽

...

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Postoperative Outcomes ◽

Symptom Duration ◽

Lumbar Interbody Fusion ◽

Preoperative Symptom

Download Full-text

Surgical Outcomes for Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion

Neurosurgery ◽

10.1227/neu.0000000000000913 ◽

2015 ◽

Vol 77 (6) ◽

pp. 847-874 ◽

Cited By ~ 90

Author(s):

Nickalus R. Khan ◽

Aaron J. Clark ◽

Siang Liao Lee ◽

Garrett T. Venable ◽

Nicholas B. Rossi ◽

...

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Minimally Invasive ◽

Radiation Exposure ◽

Interbody Fusion ◽

Operative Time ◽

Meta Analysis ◽

Transforaminal Lumbar Interbody Fusion ◽

Complication Rates ◽

Lumbar Interbody Fusion

BACKGROUND: Minimally invasive transforaminal lumbar interbody fusion (TLIF)—or MI-TLIF—has been increasing in prevalence compared with open TLIF (O-TLIF) procedures. The use of MI-TLIF is an evolving technique with conflicting reports in the literature about outcomes. OBJECTIVE: To investigate the impact of MI-TLIF in comparison with O-TLIF for early and late outcomes by using the Visual Analog Scale for back pain (VAS-back) and the Oswestry Disability Index (ODI). Secondary end points include blood loss, operative time, radiation exposure, length of stay, fusion rates, and complications between the 2 procedures. METHODS: During August 2014, a systematic literature search was performed identifying 987 articles. Of these, 30 met inclusion criteria. A random-effects meta-analysis was performed by using both pooled and subset analyses based on study type. RESULTS: Our meta-analysis demonstrated that MI-TLIF reduced blood loss (P < .001), length of stay (P < .001), and complications (P = .001) but increased radiation exposure (P < .001). No differences were found in fusion rate (P = .61) and operative time (P = .34). A decrease in late VAS-back scores was demonstrated for MI TLIF (P < .001), but no differences were found in early VAS-back, early ODI, and late ODI. CONCLUSION: MI-TLIF is associated with reduced blood loss, decreased length of stay, decreased complication rates, and increased radiation exposure. The rates of fusion and operative time are similar between MI-TLIF and O-TLIF. Differences in long-term outcomes in MI-TLIF vs O-TLIF are inconclusive and require more research, particularly in the form of large, multi-institutional prospective randomized controlled trials.

Download Full-text

Does Gender Influence Postoperative Outcomes in Minimally Invasive Transforaminal Lumbar Interbody Fusion?

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000735 ◽

2019 ◽

Vol 32 (2) ◽

pp. E107-E111 ◽

Cited By ~ 2

Author(s):

Benjamin Khechen ◽

Brittany E. Haws ◽

Dil V. Patel ◽

Kaitlyn L. Cardinal ◽

Jordan A. Guntin ◽

...

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Postoperative Outcomes ◽

Lumbar Interbody Fusion ◽

Gender Influence

Download Full-text

Iliac Crest Bone Graft for Minimally Invasive Transforaminal Lumbar Interbody Fusion

Spine ◽

10.1097/brs.0000000000002599 ◽

2018 ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Brittany E. Haws ◽

Benjamin Khechen ◽

Ankur S. Narain ◽

Fady Y. Hijji ◽

Kaitlyn L. Cardinal ◽

...

Keyword(s):

Minimally Invasive ◽

Bone Graft ◽

Interbody Fusion ◽

Iliac Crest ◽

Transforaminal Lumbar Interbody Fusion ◽

Iliac Crest Bone Graft ◽

Lumbar Interbody Fusion

Download Full-text

Postoperative Outcomes Based on American Society of Anesthesiologists Score After Minimally Invasive Transforaminal Lumbar Interbody Fusion

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000930 ◽

2020 ◽

Vol 33 (1) ◽

pp. E40-E42

Author(s):

Joon S. Yoo ◽

James M. Parrish ◽

Nathaniel W. Jenkins ◽

Benjamin Khechen ◽

Brittany E. Haws ◽

...

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Postoperative Outcomes ◽

Lumbar Interbody Fusion ◽

American Society ◽

American Society Of Anesthesiologists

Download Full-text

Application of a three-dimensional high-definition exoscope in minimally invasive transforaminal lumbar interbody fusion

10.21203/rs.3.rs-41963/v1 ◽

2020 ◽

Author(s):

Zhi-Peng Yao ◽

Chen-Jie Xiong ◽

Bi-Wang Huang ◽

Ya-Wei Yao ◽

Hui Kang ◽

...

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Complication Rates ◽

Lumbar Interbody Fusion ◽

High Definition ◽

Training Tool ◽

Advantages And Disadvantages ◽

Soft Tissue Dissection ◽

Surgical Field

Abstract Background Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is becoming increasingly popular in the treatment of lumbar degenerative diseases. Microscope assisted MIS-TLIF was also reported favorable clinical outcomes and low complication rates, while limitations can include depth of field, illumination, and ergonomics. The exoscope has been introduced as an alternative to microscopes. In this report, we describe the application of the 3-dimensional (3D), high-definition (HD) exoscope for MIS-TLIF, and discuss its advantages and disadvantages. Methods Six patients were performed 3D-HD exoscope-assisted MIS-TLIF from September 2019 to December 2019. The exoscope was used [Kestrel View II, WEALTH CONCORD MITAKA MEDICAL TECHNOLOGIESCO., LTD. OF SHANGHAI, CHINA] during soft tissue dissection, discectomy, decompression, and cage insertion. Results The exoscope provided an excellent 3D view of the surgical field and allowed us to effectively and safely perform the surgical steps. All 6 patients experienced excellent surgical outcomes. The main advantages of the 3D exoscope include the possibility to provide excellent, magnified, and illuminated 3D-HD images of the surgical field to the entire operating room and serving as an excellent training tool. Conclusion We believe that the 3D exoscope will be a safe and effective tool to perform MIS-TLIF.

Download Full-text