Brandon W. Cook

Minimally Invasive Transforaminal Lumbar Interbody Fusion versus Lumbar Lateral Interbody Fusion: Patient-Centered Results

Introduction The documented benefits of minimally invasive surgery (MIS) continue to be elucidated. These include decreased soft-tissue disruption, blood loss, and shorter hospital length of stay (LOS). The various MIS techniques have inherent benefits. The direct patient benefit of the one procedure over the other (LLIF vs. TLIF) has yet to be clinically established. We analyzed the operative time and blood loss, postoperative VAS scores, and LOS associated with each procedure. Methods A retrospective multicentered review was performed from 2008 to 2014. All patients with one and two-level MIS TLIF and LLIF procedures were included. Total operative time, blood loss, immediate postoperative, and day of discharge VAS pain scores along with LOS were recorded. Patients were divided into two groups. Group 1 had LLIF procedures. Group 2 had TLIF procedures. Results A total of 92 patients were treated during this time period. Group 1 included 52 patients. Group 2 included 40 patients. There was no difference in BMI, number of levels fused, perioperative complications, and immediate postoperative or discharge VAS scores, between the two groups. A statistically significant benefit was observed in the LLIF group compared with the TLIF group when assessing the number of patients discharged on postoperative day (POD) 1 (48 vs. 0%, p < 0.001), overall length of stay (2.1 vs. 3.5 days, p < 0.001), mean operative time (154 vs. 265 minutes, p < 0.001), and total operative blood loss (102 vs. 206 mL, p < 0.001). Conclusion The benefits of MIS surgery continue to be validated and include decreased soft-tissue damage, blood loss, and shorter hospital LOS. The overall LOS was significantly shorter in the LLIF group. There were also a greater number of patients discharged on POD 1 in the LLIF group and total operative time and blood loss were also significantly lower in the LLIF group. Further prospective analysis is required to better delineate the benefits of one procedure over the other.