Defining the MIS-TLIF: A Systematic Review of Techniques and Technologies Used by Surgeons Worldwide. Issue 2 (April 2020)

• Record Type: Journal Article
• Authors: Lener, Sara; Wipplinger, Christoph; Hernandez, R. Nick; Hussain, Ibrahim; Kirnaz, Sertac; Navarro-Ramirez, Rodrigo; Schmidt, Franziska Anna; Kim, Eliana; Härtl, Roger
• Other Names: Härtl Roger guest-editor.
• Is Part Of: Global spine journal. Volume 10:Issue 2(2020)Supplement
• Page Start: 151S
• Page End: 167S
• Publication Date: 2020-04
• Subjects: minimally invasive spine surgery -- transforaminal lumbar interbody fusion -- MIS-TLIF -- systematic review; Spine -- Diseases -- Periodicals; Spine -- Diseases -- Treatment -- Periodicals; Spine -- Abnormalities -- Periodicals; Spine -- Surgery -- Periodicals; 616.73
• DOI: 10.1177/2192568219882346
• Languages: English
• ISSNs: 2192-5682

Abstract

Study Design: Systematic review. Objective: To date there is no consensus among surgeons as to what defines an MIS-TLIF (transforaminal lumbar interbody fusion using minimally invasive spine surgery) compared to an open or mini-open TLIF. This systematic review aimed to examine the MIS-TLIF techniques reported in the recent body of literature to help provide a definition of what constitutes the MIS-TLIF, based on the consensus of the majority of surgeons. Methods: We created a database of articles published about MIS-TLIF between 2010 and 2018. We evaluated the technical components of the MIS-TLIF including instruments and incisions used as well the order in which key steps are performed. Results: We could identify several patterns for MIS-TLIF performance that seemed agreed upon by the majority of MIS surgeons: use of paramedian incisions; use of a tubular retractor to perform a total facetectomy, decompression, and interbody cage implantation; and percutaneous insertion of the pedicle-screw rod constructs with intraoperative imaging. Conclusion: Based on this review of the literature, the key features used by surgeons performing MIS TLIF include the use of nonexpandable or expandable tubular retractors, a paramedian or lateral incision, and the use of a microscope or endoscope for visualization. Approaches using expandable nontubular retractors, those that require extensive subperiosteal dissection from the midline laterally, or specular-based retractors with wide pedicle to pedicle exposure are far less likely to be promoted as an MIS-based approach. A definition is necessary to improve the communication among spine surgeons in research as well as patient education.