title: Minimally Invasive Transforaminal Lumbar Interbody Fusion in Multilevel: Comparison with Conventional Transforaminal Interbody Fusion.
abstract: OBJECTIVE
  Minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) has shown superior or noninferior results compared with conventional TLIF in single segments. There were no comparative studies between MIS and conventional TLIF in multisegments. The purpose of this study was to compare MIS and conventional TLIF in multisegments.
  
  
  METHODS
  This is a cross-sectional study of 2- or 3-segment lumbar degenerative disease that was treated with either MIS (27 cases) or conventional TLIF (43 cases). Whole spine sagittal radiography was done preoperatively and 1 year after surgery. Clinical outcomes, perioperative outcomes, and fusion rate were compared. Radiologic parameters, such as cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis, and pelvic parameters, were measured 1 year after surger.
  
  
  RESULTS
  The two groups were similar in age, sex, preoperative diagnosis, operated level, and follow-up period. Both groups showed improvement in visual analog scale and Oswestry disability index after surgery. The MIS TILF group had a significantly shorter operation time (167.10 vs. 216.58 minutes) and less blood loss (532.41 vs. 865.81 mL). Only cervical lordosis (MIS TLIF, -17.2°; conventional TLIF, -11.2°) was significantly different preoperatively between the groups. Postoperatively, there were no significant differences in radiologic parameter and fusion rate. In the intragroup comparisons, thoracic kyphosis, lumbar lordosis, and sacral slope were significantly increased and pelvic tilt was significantly decreased after surgery.
  
  
  CONCLUSIONS
  MIS TLIF and conventional TLIF showed similar clinical and radiologic outcomes. MIS TLIF may be a better choice for 2- or 3-segment lumbar fusion in perioperative outcomes.
authors.affiliation: Department of Neurosurgery, Pohang St. Mary's Hospital, Pohang, and Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Won-Chul
authors.initials: WC
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Pohang St. Mary's Hospital, Pohang, and Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: spinepjy@yuhs.ac.
authors.forename: Jeong-Yoon
authors.initials: JY
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Pohang St. Mary's Hospital, Pohang, and Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyung Hyun
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Pohang St. Mary's Hospital, Pohang, and Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Uk
authors.initials: SU
authors.lastname: Kuh
authors.affiliation: Department of Neurosurgery, Pohang St. Mary's Hospital, Pohang, and Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Dong Kyu
authors.initials: DK
authors.lastname: Chin
authors.affiliation: Department of Neurosurgery, Pohang St. Mary's Hospital, Pohang, and Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Keun Su
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Pohang St. Mary's Hospital, Pohang, and Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yong Eun
authors.initials: YE
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008141:Lordosis / Q000000981:diagnostic imaging; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011859:Radiography; D013123:Spinal Fusion / Q000379:methods*
keywords: Minimally invasive; Spinal sagittal alignment; Transforaminal lumbar interbody fusion