Is minimally invasive superior to traditional open technique for two-segmental transforaminal interbody fusion in the treatment of lumbar degenerative disease?

Abstract Study Design: Retrospective case‒control study. Purpose: To compare minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and Traditional open TLIF in the treatment of two segments lumbar degenerative diseases. Methods:Patients who underwent two-level MIS-TLIF (n = 222) and traditional open TLIF (n = 214) for lumbar degenerative disease. Demographic characteristics, surgical information, and perioperative complications were compared between the MIS-TLIF and Open TLIF groups. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and 36-Item Short Form Survey Instrument (SF-36) were administered for clinical evaluations. Results: Patients who underwent MIS-TLIF had a significantly lower volume of blood loss (176.2 ± 30.4mL vs 396.4 ± 59.7mL), lower postoperative drainage (102.6 ± 22.6 mL vs 164.4 ± 26.9mL), shorter bed rest time (3.3 d vs 4.7 d), longer operative time (201.4 ± 17.6 min vs 147.7 ± 16.0 min), and the higher fluoroscopy time (45.3 ± 6.3 seconds vs. 14.0 ± 2.3 seconds) than those who underwent Open TLIF. Significant clinical improvement was observed in terms of scores on the VAS, ODI, and SF-36 when comparing the preoperativeevaluation and the final follow-up. Postoperatively, both MIS-TLIF and open TLIF groups showed significant improvement in VAS, ODI, and SF-36 scores from 3 months to 2 years. VAS, ODI, and SF-36 scores were not different between MIS-TLIF and open TLIF groups after one year follow up. No significantly difference was found when comparing the complication rate between MI-TLIF and open TLIF groups. Conclusions:Both MIS-TLIF and Open TLIF were effective approaches for the treatment of two-level lumbar degenerative diseases. Although MIS-TLIF procedure can improve health-related quality of life for patients better than open procedure after operation, there is no significant difference in this advantage after one year operation. We decided to choose MIS-TLIF or open TLIF procedure according to the physical condition of patients and surgeons’clinical experiences.