Comparison of Minimally Invasive Versus Open Transforaminal Interbody Lumbar Fusion

Study Design: Narrative review. Objectives: In this review, we address the question of whether the literature supports the notion that minimally invasive transforaminal interbody fusion (MIS-TLIF) improves outcome as compared with open TLIF (open-TLIF). Short and long-term outcomes, fusion rate, and cost-effectiveness were reviewed. Methods: This is a narrative review using various databases. Open-TLIF and MIS-TLIF studies were included and posterior lumbar interbody fusion studies were excluded. A description of paramedian incision in surgical technique was essential to the definition of MIS-TLIF. The present review included 14 prospective observational studies and 6 randomized controlled trials. Results: With short-term outcomes, some studies indicate a better outcome with MIS-TLIF regarding intraoperative bleeding, hospital stay, time to ambulation, postoperative narcotic use, and time to resume work. Both MIS-TLIF and open-TLIF surgeries improved Oswestry Disability Index, back pain, and leg pain. Some studies show that MIS-TLIF resulted in lower back pain than open-TLIF. Radiation exposure was higher with MIS-TLIF. In the longer term, clinical outcomes were improved in both MIS and open TLIF groups. Fusion rates were more than 90% in both MIS-TLIF and open-TLIF. Cost-effectiveness and length of surgery had mixed results. Conclusions: The potential benefits of MIS-TLIF might be present in the early recovery period after surgery. Long-term outcomes were similar with both MIS-TLIF and open-TLIF.