Novel Mini-open Transforaminal Lumbar Interbody Fusion

Transforaminal lumbar interbody fusion (TLIF) is an effective and popular surgical procedure for managing various spinal pathologies, particularly degenerative diseases. Since the advent of TLIF, surgeons have pursued minimally invasive techniques. Currently, TLIF can be performed through transforaminal approaches by open surgery, minimally invasive surgery, or percutaneous endoscopy. This study provides a detailed description of a modified open TLIF with percutaneous pedicle screws, referred to as mini-open TLIF. The objective is to present the feasibility of this procedure and its preliminary results. The procedure has been performed since January 2021, and the number of patients meeting the inclusion criteria has exceeded 300. Data collected include operation time, blood loss, ambulatory time, hematocrit levels, and perioperative complications. Clinical symptoms are evaluated at 1 week, 3 months, and 12 months postoperatively. Visual analog scale (VAS) scores for lower back and leg pain and the Oswestry Disability Index (ODI) are assessed. Magnetic resonance imaging is conducted preoperatively and 12 months postoperatively to measure the cross-sectional area of paraspinal muscles. Lumbar interbody fusion rates are evaluated using CT scans. The procedure can be applied to most common lumbar degenerative diseases in clinical practice. The currently collected data indicates that the mean operation time for single level was 102.3 min and 130.2 min for multi-level procedures. Intraoperative blood loss averaged 62.5 mL for single-level and 108.3 mL for multi-level surgeries. VAS and ODI scores showed significant improvements post-surgery (p < 0.001), achieving minimal clinically important differences. Paraspinal muscle atrophy rates were 2.5% on the symptomatic side and 1.2% on the asymptomatic side. Changes in cross-sectional areas and atrophy rates are not statistically significant (p > 0.05). MO-TLIF is effective and feasible for treating lumbar degenerative diseases, especially in multi-level cases, with minimal muscle damage and shorter operation times.