However, a few historical reports have been added for completeness. Included in this search was the following key phrases: ��Minimally invasive,�� ��transforaminal,�� ��interbody fusion,�� and ��lumbar.�� We included only English language reports. Further, LY-3009104 although articles were first identified by abstract, only full text manuscripts were used to compile this review of the topic. We did not include individual case reports unless associated case series data was included. Further, inclusion criteria were based on the study’s contribution in terms of original data, technical variations, and contrasts between open and minimally invasive versions of the procedure ideally completed at the same institution. In total, 14 articles were selected on the aforementioned basis.
All contributed to the established body of the literature pertaining to lumbar arthrodesis techniques, particularly different variants of TLIF. Six of the 14 articles were prospective studies, while the remaining 8 were retrospective (Table 1). Table 1 Summary of research studies reporting data on MI-TLIF. 3. MI-TLIF Technique After failed conservative management for a minimum of 6 months, surgery becomes the next therapeutic option for patients presenting with degenerative disc disease (DDD), radiculopathy with spinal instability, and/or grade 1 spondylolisthesis. Initially patients are assessed through radiological investigations including X-ray (AP, lateral, flexion, and extention), and noncontrast lumbosacral MRI.
Length of hospitalization is determined by postoperative pain control and functional dependence, with patients of advanced age or medical comorbidities often requiring longer postoperative recovery. However, a majority of patients are admitted the day of surgery and discharged within 24�C72 hours after operation. Under general anesthesia, patients are fixed in a Wilson frame in a prone position. The patient is prepped and draped in standard fashion, and a fluoroscopic C-arm is positioned in the sterile field. Under fluoroscopic guidance the appropriate level is marked and a 3cm incision is made 4.5cm of off midline. A k-wire is targeted to the bony complex at the surgical level and serial dilators are consecutively passed to split the muscle fibers. Proper orientation is confirmed by fluoroscopic imaging.
A working channel is placed, the dilators are removed, and the channel is secured appropriately for adequate visualization of the medial portion of the facet and inferior lamina. A curette is used to detach the ligamentum flavum from the inferior edge of the lamina, and Drug_discovery a kerrison is used to perform the hemilaminectomy. The unilateral facet can be removed using an osteotome or high-speed drill. Following adequate exposure of the disc space, a discectomy is performed using a pituitary rongeur and curette. Curved and angled curettes and a disc scraper are then used to prepare the end plate.