TITLE:
Standardizing MI-TLIF, a Proposal for a Reproducible Technique
AUTHORS:
Iván Ulises Sámano López, Jesús Alberto Pérez Contreras, Emmanuel Cantú Chávez, Diana Chávez Lizárraga, Ana Sofía Peña Blesa, Thania Karina Gutiérrez Anchondo
KEYWORDS:
MITLIF, Lumbar Interbody Fusion, Technique, Pain Relief and Disability
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.14 No.2,
February
29,
2024
ABSTRACT: Background: Minimally invasive transforaminal lumbar interbody fusion (MI TLIF) is a widely known and performed technique, however its versatility among different physicians continues to hinder its replication and results. Therefore, this study aimed to provide a step-by-step surgical guide to perform a safe MI-TLIF, based on the results obtained in patients operated on by a single surgeon over a period of 12 years. Patients and methods: A retrospective, single center, longitudinal, and observational cohort study was conducted with 931 patients who underwent MI TLIF by a single surgeon between 2010 and 2022 using the technique described on this paper, each with a minimum follow-up of 12 months. Criteria included Schizas classification, listhesis according to Meyerding classification, number of levels treated, cage size, and complications (screw repositioning or cerebrospinal fluid leak). Patient clinical outcomes were assessed using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) for pre- and postoperative radicular pain. Thin slice CT scans were used to assess the progression of the fusion using the Bridwell classification. In the statistical analysis, percentages, median, and interquartile range (IQR) were calculated. Results: Nine hundred and thirty one patients underwent MI TLIF using the technique described, eight hundred and eighty (94.5%) had a single level treated and fifty one (5.5%) had a 2 level procedure (982 levels), an 8mm cage was placed on five hundred and seventeenlevels (52.7%), six hundred and sixty three levels(67.6%) achieved grade I fusion, two hundred and sixty six levels (27.1%) achieved grade II fusion, 52 levels (5.3) achieved grade III fusion and one level (0.1) achieved a grade IV fusion or non-union. Revision surgery was performed on 3 patients (0.3%) for screw repositioning, cerebrospinal fluid leak was present on 2 patients during surgery and treated before closure. VAS scores and ODI were improved at 12 months postop (VAS from 8.70 to 2.30 and ODI from 34.2 to 14.1, (p = 0.001). Conclusions: The MI TLIF technique described could be a safe and easy to replicate way to achieved lumbar interbody fusion, providingclinical and radiological benefits.