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Background: The concept of minimally invasive techniques is to make every effort to reduce tissue damage. Certainly, reducing skin incision is an important part of these techniques. This study aimed to investigate the clinical feasibility of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion (TLIF) with a small single posterior median incision. Methods: During the period of March 2011 to March 2012, 34 patients with single-segment degenerative lumbar disease underwent the minimally invasive modified TLIF assisted by Mast Quadrant with a small single posterior median incision (single incision group). The cases in this group were compared to 37 patients with single-segment degenerative lumbar disease in the double incision group. The perioperative conditions of patients in these two groups were statistically analyzed and compared. The Oswestry Disability Index (ODI) scores, Visual Analog Scale (VAS) scores, and sacrospinalis muscle damage evaluation indicators before operation and 3, 12 months postoperation were compared. Results: A total of 31 and 35 cases in the single incision and double incision groups, respectively, completed at least 12 months of systemic follow-up. The differences in perioperative conditions between the two groups were not statistically significant. The incision length of the single incision group was significantly shorter than that of the double incision group (P < 0.01). The ODI and VAS scores of patients in both groups improved significantly at 3 and 12 months postoperation. However, these two indicators at 3 and 12 months postoperation and the sacrospinalis muscle damage evaluation indicators at 3 months postoperation did not differ significantly between the two groups (P ≥ 0.05). Conclusions: Mast Quadrant-assisted modified TLIF with a small single posterior median incision has excellent clinical feasibility compared to minimally invasive TLIF with a double paramedian incision.

Background Minimally invasive spine surgery has seen rapid development in recent years. The purpose of this study was to evaluate the use of unilateral biportal endoscopic lumbar interbody fusion (ULIF) versus minimally invasive surgery transforaminal interbody fusion (MIS-TLIF) for the treatment of single-segment lumbar degenerative disease (LDD) through a systematic review and meta-analysis. Methods In collaboration with various search terms, a comprehensive examination of the scientific literature was carried out using PubMed, China National Knowledge Infrastructure (CNKI), Wanfang, and other databases. A total of 9 studies were included retrospective cohort studies. Results We observed statistically significant differences in intraoperative blood loss, total hospital stay, postoperative hospital stays, and 1-month postoperative Oswestry Disability Index (ODI) scores between the ULIF and MIS-TLIF groups, with the ULIF group being more dominant. MIS-TLIF group was statistically more advantageous in terms of operative time. There were no statistically significant differences in postoperative visual analogue scale (VAS) scores, 3-month postoperative and final ODI scores, excellent and good rate, complications, disc heights, and lumbar lordosis angle between the two groups. Conclusions Treatment of single-segment LDD with ULIF and MIS-TLIF is both safe and effective. ULIF has the advantage of less intraoperative blood loss, shorter total hospital stay, shorter postoperative hospital stay, and lower ODI scores at 1 month postoperatively compared to MIS-TLIF. There were no significant differences between ULIF and MIS-TLIF in the treatment of LDD in terms of postoperative VAS scores, 3-month postoperative and final ODI scores, satisfaction rates, fusion rates, complications, disc heights, and lumbar lordosis angle. MIS-TLIF has a shorter procedure time than ULIF.

Background： The previous studies agree that minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） has better function outcomes, less blood loss, and shorter hospital stay, when compared to open-TLIF. However, there are no significance differences on operative time, complication, and reoperation rate between the two procedures. This could be from less relative literatures and lower grade evidence. The further meta-analysis is needed with more and higher grade evidences to compare the above two TLIF procedures. Methods： Prospective and retrospective studies that compared open-TLIF and MIS-TLIF were identified by searching the Medline, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP database （the literature search comprised Medical Subject Heading terms and key words or Emtree term）. The retrieval time ranged from the date when the database was founded to January 2015. Pooled risk ratios （RRs） and weighted mean differences （WMDs） with 95% confidence intervals were calculated for the clinical outcomes and perioperative data. Results： Twenty-four studies （n =1967 patients） were included in this review （n =951, open-TLIF, n 1016, MIS-TLIF）. MIS-TLIF was associated with a significant decrease in the visual analog score （VAS）-back pain score （WMD 0.44; P= 0.001）, Oswestry Disabilities Index （WMD 1.57; P =0.005）, early ambulation （WMD = -1.77; P = 0.0001）, less blood loss （WMD = -265.59; P 〈 0.00001）, and a shorter hospital stay （WMD =-1.89; P 〈 0.0001）. However, there were no significant differences in the fusion rate （RR =0.99; P = 0.34）, VAS-leg pain （WMD = -0.10; P = 0.26）, complication rate （RR = 0.84; P = 0.35）, operation time （WMD = 5.23; P = 0.82）, or reoperation rate （RR = 0.73; P = 0.32）. Conclusions： MIS-TLIF resulted in a similar fusion rate with better functional outcome, less blood loss, shorter ambulation, and hospital stay; furthermore, it did not increase the complication or reoperation rate based on the existing evidence.

Purpose This study aimed to evaluate the clinical efficacy and imaging results of percutaneous endoscopic transforaminal lumbar interbody fusion (PETLIF) through comparing it with minimally invasive surgery-transforaminal lumbar interbody fusion (MISTLIF). Materials and methods We performed a retrospective analysis on patients with lumbar degenerative disease treated by PETLIF or MISTLIF from September 2017 to January 2019, and the patients were divided into two groups: the PETLIF group and the MISTLIF group. The clinical and imaging parameters of the two groups were evaluated. Results There was no significant difference between the two groups in complication rate. The operative time in the PETLIF group was significantly less than that in the MISTLIF group. Compared with those before operation, the postoperative VAS-L and VAS-B scores were significantly improved after operation in the both groups. In addition, the postoperative VAS-B score of the PETLIF group was significantly lower than that of the MISTLIF group. At the last follow-up, there was no significant difference between the two groups in the VAS-L score, VAS-B score, ODI score, and bony fusion rate. Conclusions Both PETLIF and MISTLIF could achieve satisfactory clinical outcomes in the treatment of lumbar degenerative disease, but our study suggested that PETLIF had less damage, rapid recovery after operation, and short discharge time.

Study Design: The study design was a retrospective study. Objective: The objectives of the present study are dual; to describe a simple and effective way of restoring intervertebral disc (IVD) height by the \"Insert Flip Technique\" of cage insertion and to demonstrate effective restoration of IVD height and segmental lordosis (SL) and their influence on the functional outcome postoperatively. Methods: IVD height and SL were recorded pre- and postoperatively. Each motion segment was instrumented with pedicle screws to allow segmental stabilization. Patients were called for follow-up at 6 weeks, 3 months, and 1 year postoperatively and were assessed clinically for back pain and leg pain (VAS and Oswestry Disability Index scores recorded). The bullet cages are designed such that they are lordotic in the superior-inferior plane and neutral in the mediolateral plane. Usually, the cage is inserted with superior and inferior surfaces of the cage impacting against superior and inferior end plates of the adjacent vertebral body. However, with the proposed technique, the cages were inserted such that the narrower mediolateral surfaces of the cage engaged with superior and inferior vertebral end plates. The cage was then flipped within the disc space such that the superior-inferior surfaces of the bullet cage impacted against the superior and inferior end plates of the vertebral body to create desired lordosis. Results: There was a significant improvement seen in the postoperative Cobb's angle and disc height after placement of a tall bullet cage compared to the preoperative Cobb's angle and disc height. Conclusion: This modification of technique helped in gaining lordosis with taller bullet cages in minimally invasive surgery transforaminal lumbar interbody fusion with no/minimal complication and also reduced the need for bone resection during insertion of the cage.

Study Design: This was a prospective case series of 30 patients with post-discectomy syndrome with an average of 18 months of follow-up (level IV).Purpose: The efficacy of post-discectomy syndrome managed by minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) was evaluated.Overview of Literature: In post-discectomy syndrome wherein conservative treatment had failed, the best surgical treatment modality still remains controversial.Methods: Patients were functionally assessed using the Visual Analog Scale (VAS) for low back pain (LBP) and leg pain (LP) and Oswestry Disability Index (ODI). Radiological fusion was confirmed with plain X-rays and when indicated with computed tomography scan at 12 months postoperatively. A total of 30 patients with 37 operated at lumbar levels with failed discectomy surgery who met our inclusion criteria were treated with MIS-TLIF.Results: The ODI of all patients showed significant improvement from a mean of 73.78% preoperatively to 16.67% at 1 month and 14.13% at 12 months postoperatively. The preoperative LBP VAS score (mean, 4.37) showed a significant decrease (p <0.001) to 1.90 at 1 month and 1.10 at 12 months. Preoperative LP VAS score of limb pain averaged 7.53 and showed a significant (p <0.001) decrease to 3.47 at 1 month and 1.10 at 12 months. All patients attained radiological fusion at 12 months.Conclusions: MIS-TILF constitutes a valid and effective treatment option for patients with post-discectomy syndrome.

The application of minimally invasive surgery (MIS) for the treatment of lumbar degenerative disease and deformity has gained popularity. Minimally invasive lumbar fusion techniques have the potential to reduce blood loss, decrease postoperative back pain, and decrease the length of hospital stay compared to open fusion surgery techniques. Minimally invasive surgery for transforaminal lumbar interbody fusion (MIS-TLIF) is the most commonly used minimally invasive technique for patients who have spondylolisthesis. Compared to open fusion techniques, MIS-TLIF is technically more challenging due to the limited exposure of the surgical field; this requires the surgeon to have a detailed anatomical knowledge of the lumbar spine.

BACKGROUND: Percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) has been increasingly used to treat degenerative lumbar disease in recent years. However, there are still controversies about whether PE-TLIF is superior to minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). OBJECTIVES: To compare clinical outcomes and complications of PE-TLIF and MIS-TLIF in treating degenerative lumbar disease. STUDY DESIGN: A systematic review and meta-analysis. METHODS: A comprehensive search of online databases including PubMed, Embase, and the Cochrane Library was performed to identify related studies reporting the outcomes and complications of PE-TLIF and MIS-TLIF for degenerative lumbar disease. The clinical outcomes were assessed by the Visual Analog Scale and Oswestry Disability Index. In addition, the operative time, intraoperative blood loss, time to ambulation, length of hospital stay, fusion rate, and surgery-related complications were summarized. Forest plots were constructed to investigate the results. RESULTS: A total of 28 studies involving 1,475 patients were included in this meta-analysis. PE-TLIF significantly reduced operative time, intraoperative blood loss, time to ambulation, and length of hospital stay compared to MIS-TLIF. Moreover, PE-TLIF was superior to MIS-TLIF in the early postoperative relief of back pain. However, there were no significant differences in medium to long-term clinical outcomes, fusion rate, and incidence of complications between PE-TLIF and MIS-TLIF. LIMITATIONS: The current evidence is heterogeneous and most studies included in this meta-analysis are nonrandomized controlled trials. CONCLUSIONS: The present meta-analysis indicates that medium to long-term clinical outcomes and complication rates of PE-TLIF were similar to MIS-TLIF for the treatment of degenerative lumbar disease. However, PE-TLIF shows advantages in less surgical trauma, faster recovery, and early postoperative relief of back pain. KEY WORDS: Percutaneous endoscopic transforaminal lumbar interbody fusion, minimally invasive transforaminal lumbar interbody fusion, degenerative lumbar disease, chronic pain, systematic review, meta-analysis

Abstract BACKGROUND In minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), cage type and position play important roles in fusion achievement and sagittal alignment correction. However, no prospective randomized comparison of the results using different types of cage has been reported to date. OBJECTIVE To compare the radiological and clinical outcomes of unilateral MIS-TLIF using 2 types of cage. METHODS All candidates for single-level MIS-TLIF were randomized into banana-shaped cage and straight-cage groups. Plain radiographs and computed tomography scans were used for assessment of cage positions, fusion status, disc height, segmental lordotic angle, cage subsidence, and pelvic parameters. Clinical outcome was assessed using visual analog scale and Oswestry Disability Index scores. RESULTS Forty-four and 40 consecutive patients were operated on using banana-shaped and straight cages, respectively. Cage position was more anterior and lateral in the straight-cage group and more medial and posterior in the banana-shaped cage group. Solid fusion was achieved in 95.2% and 96.6% of the 2 groups, respectively, at 12 mo. The change in disc height and segmental lordotic angle postoperatively was significantly greater in the banana-shaped cage group. The incidence of subsidence during follow-up was significantly higher in the banana-shaped cage group (P < .04). Clinically, the visual analog scale and Oswestry Disability Index scores decreased significantly after surgery in both groups, with no significant difference between the groups. CONCLUSION Our preliminary outcomes suggest that the subsidence rate may be higher using banana-shaped cages in MIS-TLIF, possibly due to their more medial final position.