title: Modified minimally invasive transforaminal lumbar interbody fusion using a trans-multifidus approach: a safe and effective alternative to open-TLIF.
abstract: BACKGROUND
  Application of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is limited by long fluoroscopy time and a steep learning curve. Herein, MI-TLIF was modified using a trans-multifidus approach, assisted by microscope, termed MMI-TLIF, and the clinical outcomes of MMI-TLIF and open-TLIF were compared.
  
  
  METHODS
  Forty-nine patients treated with MMI-TLIF were matched with 49 subjects who underwent open-TLIF. Patients were assessed using the North American Spine Society Score (NASS), Oswestry Disability Index (ODI), Short Form-36 (SF-36), and Visual Analogue Score (VAS) before surgery and during follow-up (6 months and 2 years). The four-type Bridwell anterior fusion grading system was used to evaluate fusion rates at 2 years.
  
  
  RESULTS
  The median fluoroscopic time did not differ significantly between the MMI-TLIF and open-TLIF groups. MMI-TLIF surgery took significantly longer than open-TLIF (91.3 vs. 82.5 min; P < 0.05). Meanwhile, MMI-TLIF patients lost significantly less blood than open-TLIF patients (75.3 vs. 215.2 ml; P < 0.05), and MMI-TLIF patients were hospitalized for less long than open-TLIF patients (3.7 vs. 6.9 days; P < 0.05) and reported less pain, faster ambulation, and lower morphine intake than open-TLIF patients (all P < 0.05). The NASS, ODI, VAS, and SF-36 scores were significantly improved 6 months and 2 years postsurgery in both groups, compared with preoperative values, and similar values were obtained for both groups. Finally, fusion rates were similar in MMI-TLIF and open-TLIF patients.
  
  
  CONCLUSIONS
  Overall, these findings strongly suggest the superiority of MMI-TLIF to open-TLIF. Therefore, MMI-TLIF could be a safe and effective alternative to MI-TLIF and open-TLIF.
authors.affiliation: Department of Orthopaedics, Anhui Medical University affiliated Provincial Hospital, Hefei, 230001, China. zwzfp@163.com.
authors.forename: Wenzhi
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, Anhui Medical University affiliated Provincial Hospital, Hefei, 230001, China. lixuaph@yeah.net.
authors.forename: Xu
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Anhui Medical University affiliated Provincial Hospital, Hefei, 230001, China. shangxifuaph@126.com.
authors.forename: Xifu
authors.initials: X
authors.lastname: Shang
authors.affiliation: Department of Orthopaedics, Anhui Medical University affiliated Provincial Hospital, Hefei, 230001, China. xuxiangaph@126.com.
authors.forename: Xiang
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Orthopaedics, Anhui Medical University affiliated Provincial Hospital, Hefei, 230001, China. huyefengaph@126.com.
authors.forename: Yefeng
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Orthopaedics, Anhui Medical University affiliated Provincial Hospital, Hefei, 230001, China. heruiaph@126.com.
authors.forename: Rui
authors.initials: R
authors.lastname: He
authors.affiliation: Department of Orthopaedics, Anhui Medical University affiliated Provincial Hospital, Hefei, 230001, China. duanliqunaph@126.com.
authors.forename: Liqun
authors.initials: L
authors.lastname: Duan
authors.affiliation: Department of Orthopaedics, Anhui Medical University affiliated Provincial Hospital, Hefei, 230001, China. lingxiaodongaph@126.com.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Ling
authors.affiliation: Department of Orthopaedics, Anhui Medical University affiliated Provincial Hospital, Hefei, 230001, China. zhangfengaph@126.com.
authors.forename: Feng
authors.initials: F
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D013123:Spinal Fusion / Q000379:methods* / Q000706:statistics & numerical data; D055815:Young Adult