Introduction: The trend of using smaller operative corridors and minimal access spine technique has rapidly evolved in neurosurgery over the past 2 decades. Minimally Invasive Transforaminal lumbar interbody (MIS-TLIF) fusion and Transpsoas approach for lateral lumbar interbody fusion have been performed for many years with good clinical outcomes. While numerous studies have demonstrated excellent results following both procedures, no clear consensus has been established as to which procedure is preferred. The primary aim of the study was to compare post-operative clinical outcomes and complication rates following both surgical approaches.
Methods: A nationwide, multi-institutional, prospective spine outcomes registry was utilized for this study. 96 patients underwent MIS-TLIF for degenerative disc disease or spondylolisthesis, while 73 patients underwent XLIF. Patients completed the Oswestry Disability Index (ODI), MOS Short Form 36 (SF-36), and back and leg pain numerical rating scores before surgery then at 3, 6, 12, and 24 months after surgery. Clinical outcomes and complication rates were compared between both cohorts.
Results: Both cohorts were similar at baseline. Statistically significant improvements from baseline were observed in both cohorts in all outcome metrics (ODI,VAS-BP/LP), SF-36 MCS/PCS. Both XLIF and MIS-TLIF patients showed similar 2-year improvement in VAS for back pain(XLIF: 3.24 ± 3.53 vs. MIS-TLIF: 3.14 ± 3.11,p=0.84), VAS for leg pain(XLIF: 3.64 ± 3.54 vs. MIS-TLIF: 2.87 ± 3.88,p=0.18), Oswestry Disability Index (XLIF: 16.56 ± 20.93 vs. MIS-TLIF: 15.27 ± 20.69,p=0.38), and SF-36 PCS(XLIF: 11.32 ± 14.01 vs.
MIS-TLIF: 11.37 ± 16.61,p=0.98), and SF-36 MCS(XLIF: 8.97 ± 20.14 vs.
MIS-TLIF: 5.17 ± 20.88,p=0.23). Patients undergoing MIS-TLIF had significantly higher complications rates compared to XLIF (8.33% vs. 3.47%, p=0.01)
Conclusions: Our study suggests that both MIS-TLIF and XLIF result in significant clinical benefit in patients presenting with symptomatic degenerative disc disease or spondylolisthesis, however, Patients undergoing MIS-TLIF had significantly higher complication rate.
Patient Care: This research shows clinical benefit of one surgical approach versus another.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Compare benefits of MIS-TLIF and XLIF and 2) compare the complications of MIS-TLIF and XLIF