Minimally Invasive (TLIF)
The advent of minimally invasive surgery has provided surgeons new techniques for treating clinical disease. There have been several innovations and inventions to assist in the field of spinal surgery. Techniques in lumbar interbody arthrodesis have shown a continued evolution of procedural approach and instrumentation.
Minimally invasive spine surgery aims to reduce approach related morbidity. It also aims to produce clinical outcomes comparable to its open predecessors in surgery. The development of minimally invasive techniques for lumbar interbody fusion is one such example of this. It includes the transforaminal lumbar interbody fusion (TLIF). We, at Spine Physicians Institute, have treated many patients with this and received very positive outcomes with the procedure.
Benefits and Challenges of Minimally Invasive TLIF
The minimally invasive TLIF has repeatedly displayed comparable outcomes to open TLIF. It also adds the benefits of;
- Less approach-related morbidity
- Decreased intraoperative blood loss
- Shorter hospital stays
There are critics of this technique who insist that it has longer operative times. They also insist that the patients are unnecessarily exposed to increased fluoroscopic radiation. However, over the past decade Minimally Invasive TLIF has been shown to have a number of benefits. Its benefits are especially visible with regard to peri-operative outcomes.
But it also has its own unique challenges and potential morbidity. A complete comparison between the traditional open TLIF and minimally invasive TLIF can be made by comparing the known literature. The published reports outline the unique benefits and risks associated with both. This understanding may help guide improved clinical decision making for many patients. Specifically, patients presenting with spondylolisthesis, lumbar instability, or lumbar degenerative disk disease.
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The Necessary Skill Required
The operative surgeon additionally must be familiar with 3D lumbar anatomy. Moreover, the physician must be able to carefully interpret 2D radiographic images to make a mental reconstruction. This is a unique skill and one that is not as critical with a traditional, open approach. The surgeon must be able to read anterior-posterior and lateral imaging. This will allow the surgeon to accurately insert percutaneous pedicle screws. Thereby allowing for possible misinterpretation leading to complications. Screw misplacement and cage migration or subsidence accounted for 44.8% of complications reported in minimally invasive TLIF comparative studies.
Once the procedure is successfully mastered, its application can positively impact patient care in many ways. But, the fundamental advantage of minimally invasive TLIF comes from its decrease in tissue trauma and overall exposure of the patient.
For more questions, contact our offices located in Dallas, Irving, Red Oak, Plano, Southlake, Grapevine, Colleyville and Duncanville marketplaces.