Current Controversies in Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion


Transforaminal lumbar interbody fusion (TLIF) is an effective tool for correcting foraminal pathology, allowing both direct and indirect decompression of spinal stenosis and the visualization of far-lateral osteophytes. However, significant controversy exists regarding the utility and efficacy of the minimally invasive surgical (MIS) approach for TLIF compared with open TLIF techniques. Critical review of the available literature suggests that the MIS TLIF procedure compares favorably with the open approach, with demonstrated improvements in short-term clinical outcomes and reduced costs with MIS TLIF, and largely similar rates of fusion and complication between the two approaches. However, implementation of MIS TLIF is associated with a significant surgeon learning curve. Ultimately, the decision to implement MIS TLIF depends on the surgeon, and requires an investment in time and resources to learn and perfect it, so as to minimize complications and maximize clinical and functional outcomes.

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