Mini-open Transforaminal Lumbar Interbody Fusion
Teera Tangviriyapaiboon MD*
Affiliation : * Department of Neurosurgery, Prasat Neurological Institute, Bangkok
Objective : To demonstrate the surgical technique and advantages of the mini-open transforaminal approach
for lumbar interbody fusion (TLIF) combined with transpedicular screw fixation. Clinical and radiographic
results were assessed to determine the clinical outcomes in twelve consecutive patients selected for minimally
invasive access (mini-open technique) for TLIF in Prasat Neurological Institute.
Material and Method: A retrospective analysis was performed on 12 patients (age range, 38-74 yr; mean, 54.8
yr) who underwent mini-open transforaminal approach for lumbar interbody fusion (TLIF) combined with
transpedicular screw fixation between September 2006 and June 2008. The titanium pedicle screws were
introduced bilaterally through the 3.5 cm length, skin incisions with Spine Classics MLD- system retractor,
autologous bone graft were inserted to perform TLIF in all patients. Eight patients were augmented anterior
column support with titanium interbody cage, unilateral cage insertion in four patients and the others were
inserted bilaterally interbody cages. Six patients presented with low back pain and associated radiculopathy,
and six presented with low back pain only. Transforaminal lumbar interbody fusion was performed at L3-L4 in
two patients, L4-L5 in four patients, L5-S1 in five patients, and two levels fusion in one patient.
Results : All patients were able to ambulate after spinal fusion. The patients were able to walk within 1.4 days
(range 1-2 days). The hospital stay averaged 4.4 days (range 3-7 days). Periodic follow-up took place 1 to 21
months after surgery (mean, 7.4 months). The radiological fusion was archived in all nine patients who were
operated on more than two months age. The other three patients who had been follow-up less than two months
were probably fusion on the 1-month followed-up radiological examination.
Conclusions: The use of mini-open technique for pedicle screw instrumentation with spinal fusion procedure
provides excellent clinical results and may be an operation of choice for lumbar spinal fusion in selected
patients.
Keywords : Pedicle screw, Minimally invasive spinal fusion, Mini-open transpedicular screws fixation, Mini- open transforaminal lumbar interbody fusion
