Minimally invasive transforaminal lumbar interbody fusion: Technical tips, learning curve, short-term clinical outcome, and brief review

BACKGROUND: Current trends in spine surgeries have shifted to minimally invasive procedures. Minimally invasive approaches are getting more popular for lumbar interbody fusion procedures. OBJECTIVES: The objective of the study was to report technical modifications, learning curve, and short-term clinical results in minimally invasive transforaminal interbody fusion (MITLIF). MATERIALS AND METHODS: All MITLIF cases performed from 2018 July to March 2020 were included. First three authors were operating surgeons. Visual analog scores (VAS) scoring for pain, Macnab criteria, and Oswestry disability index (ODI) were used for outcome assessment. Operating time, radiation exposure, and complications were assessed separately in a group of 20 as per time sequence in series to assess the learning curve. RESULTS: A total of 61 patients were included. Various indications included spondylolisthesis, failed back surgery, calcified lumbar disc, and spondylodiscitis. Mean age was 47.08 ± 12.06. Intraoperative blood loss was 97.04 ± 25.58. Mean operating time and number of C-arm shots were 190.75 ± 37.11 and 159.3 ± 74.54, respectively, in initial 20 cases which however reduced in later operated cases. Significant improvement in VAS and ODI scores was observed at follow-up of 6.34 ± 4.67 months. Three cases needed surgical revision in the initial 20 cases, and there were no revision surgeries in later operated cases. CONCLUSION: MITLIF could be done in failed back surgery cases, spondylodiscitis, and deformity corrections in addition to spondylolisthesis. It has advantages of less injury to soft tissues, maintaining the posterior tension band, decrease in blood loss and hospital stays, and early mobilization. However, it has longer learning curve and takes minimum 20 cases for the surgeon to acquire reasonable experience and confidence.