Modified Mini Open-TLIF as effective as MIS-TLIF for lumbar degenerative disease: study

Shengwen Li et al conducted a study to compare the clinical and radiological outcomes of modified mini-open transforaminal lumbar interbody fusion (mMO-TLIF) via posterior midline incision for "targeted limited dissection" versus minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF) via Wiltse approach in lumbar degenerative diseases.

The study has been published in ‘Indian journal of orthopedics.’

A total of 60 consecutive patients in single centre were enrolled, including 30 patients who were treated with mMO-TLIF via posterior midline incision and 30 treated with MIS-TLIF through the Wiltse approach. Perioperative parameters were recorded. The questionnaires of Oswestry Disability Index (ODI) and Visual Analogue Score (VAS) were conducted before the operation and after the operation (3 days, 1 week, and 2 years). CT and MRI radiological outcomes were evaluated before the operation and at a 2-year follow-up.

Key findings of the study were:

• There were no significant differences in the general data, gender, age, and BMI between the two groups.

• All patients were successfully operated without intraoperative complications.

• There were significant differences between the two groups in the operation time (p<0.001) and intraoperative bleeding (p<0.05).

• There was no difference in ODI and VAS scores between groups pre- and post-operatively, but they were both significantly improved compared to those before the operation (p<0.01).

• At a 2-year follow-up, the paraspinal muscle atrophy and fat infiltration were increased comparing to pre-operation, but the difference was also not statistically significant (p>0.05).

• In addition, both the two groups’ fusion rates were more than 90% at a 2-year follow-up, however, no difference was detected between the two groups.

The authors concluded that – ‘The mMO-TLIF via the posterior midline incision for "targeted limited dissection" and MIS-TLIF via the Wiltse approach achieve similar clinical and radiological satisfaction for lumbar degenerative disease. The mMO-TLIF is beneficial to tissue exposure, operation time, and intraoperative bleeding.’

Further reading:

Comparison of mMO TLIF via Midline Incision Versus MIS TLIF via Wiltse Approach in Lumbar Degenerative Disease Shengwen Li et al Indian Journal of Orthopaedics https://doi.org/10.1007/s43465-024-01150-2