Modified Mini-Open Transforaminal Lumbar Interbody Fusion (MOTLIF): Description of Surgical Technique and Assessment of Free-Hand Pedicle Screw Insertion.
Spine (Phila Pa 1976). 2016 Feb 23;
Authors: Pakzaban P
STUDY DESIGN: Retrospective case series OBJECTIVE.: To describe a modified technique for miniopen transforaminal lumbar interbody fusion (TLIF) which improves visualization for decompression, fusion and free-hand pedicle screw insertion. Accuracy of free-hand pedicle screw placement with this technique was assessed.
SUMMARY OF BACKGROUND DATA: Mini-open TLIF is a minimally invasive technique that allows limited visualization of the boney and neural anatomy via an expandable tubular retractor inserted through the Wiltse plane. No significant modification that of this technique has been described in detail.
METHODS: 92 consecutive patients underwent one-level modified mini-open TLIF (MOTLIF). MOTLIF modifications consisted of: trans-muscular dissection through the multifidus muscle rather than inter-muscular dissection in the Wiltse plane; microsurgical detachment of multifidus from the facet rather than muscle dilation; en bloc total facetectomy (unilateral or bilateral, as needed for decompression); facet autograft used for interbody fusion; solid pedicle screws placed bilaterally by a free-hand technique under direct vision.
RESULTS: The mean age was 53 years. Mean follow-up was 35 months (minimum 2 years). By 6 months, mean VAS for back and leg pain had improved from 51 to 19 and from 58 to 17, respectively, and mean ODI improved from 53 to 16. These improvements persisted at 2 years. Solid fusion, defined by computed tomography (CT) at 1 year, was achieved in 88.1%, while satisfactory fusion was achieved in 95.2% of patients. Pedicle screws were accurately placed in 335 of 336 imaged pedicles (pedicle breach grades: 91.1% Grade 1; 8.6% Grade 2; 0.3% Grade 3). Mean fluoroscopy time was 29.3 seconds.
CONCLUSION: MOTLIF is a safe and effective minimally invasive technique with a high fusion rate. It allows accurate pedicle screw placement by a free-hand technique. By eliminating bi-planar fluoroscopy, it helps reduce radiation exposure. This is the largest published report of mini-open TLIF to date.
LEVEL OF EVIDENCE: 4Supplemental Digital Content is available in the textThis is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0 License, where it is permissible to download and share the work, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0.
PMID: 26909829 [PubMed – as supplied by publisher]