Tag: Minimally invasive transforaminal lumbar interbody fusion

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Spinal versus general anesthesia in robotic minimally invasive transforaminal lumbar interbody fusion: a comparative study on surgical outcomes

J Neurosurg Spine 44:99–107, 2026

This clinical study compares spinal anesthesia (SA) versus general anesthesia (GA) for robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA‑MIS TLIF), reporting retrospective outcomes from 209 patients treated 2018–2024. Primary findings show SA patients had significantly shorter operative times, lower immediate postoperative pain scores, reduced estimated blood loss, and shorter hospital length of stay after propensity score matching and regression adjustment.

The authors contextualize results within advances in robotic spinal surgery and awake spine techniques, discuss safety and potential cost and opioid‑reduction benefits, and acknowledge limitations including retrospective design, single‑center data, and reduced matched cohort size. Conclusions support SA as a safe, efficient approach for RA‑MIS TLIF with calls for larger prospective studies and formal patient‑selection guidelines.

Spinal Anesthesia (SA) vs General Anesthesia (GA): In robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA-MIS TLIF), SA significantly reduces operative times, postoperative pain, and hospital length of stay compared to GA, with no increase in complications or adverse outcomes.

Robotic Assistance Benefits: Robotic technology in spine surgery improves pedicle screw placement accuracy, reduces radiation exposure, and is associated with lower complication and revision rates, enhancing surgical safety and efficiency.

Study Design: A retrospective analysis of 209 patients (31 SA, 178 GA) from 2018–2024, with propensity score matching applied to control for confounders, allowing fair comparison between SA and GA cohorts for single-level procedures.

Key Outcomes (After Matching): SA cohort had shorter median total OR time (159 vs 283 min), procedure time (115 vs 201 min), lower intraoperative blood loss (25 vs 50 mL), lower first postoperative pain scores (median VAS 0 vs 5), and reduced mean length of stay (0.90 vs 2.64 days) compared to GA.

Patient Selection: The choice between SA and GA was based on patient preference and eligibility, with all SA cases being single-level procedures and comparable baseline demographics after matching.

Safety Profile: No increase in intraoperative or postoperative complications was observed with SA; screw placement accuracy remained high with robotic assistance.

Implications for Practice: Combining SA with RA-MIS TLIF offers a safe, efficient, and patient-centered approach that may lower healthcare costs and opioid requirements by reducing pain and hospitalization.

Limitations: Single-center, retrospective design with a relatively small matched cohort may limit generalizability; further prospective, multicenter studies are needed to validate these findings.

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Spinal Anesthesia for Multilevel Awake Minimally Invasive Transforaminal Lumbar Interbody Fusion

Operative Neurosurgery 28:855–861, 2025

This retrospective study found that multilevel awake minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) under spinal anesthesia is safe and effective, with minimal blood loss, good pain control, and short hospital stays, supporting its use even in complex cases for improved patient outcomes.

• Multilevel awake minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) under spinal anesthesia is safe and effective for complex lumbar spine cases.

• A retrospective review of 16 patients (mostly two-level procedures) showed no new neurological deficits and all were discharged home without complications.

• Median age was 69.5 years; common comorbidities included hypertension, obesity, and sleep apnea.

• Median operative time was 156 minutes, with low median blood loss (50 mL) and a median hospital stay of 2 days.

• Postoperative pain was well controlled, most commonly using methocarbamol and short-duration opioids.

• 93.75% of patients reported significant symptomatic improvement at follow-up.

• Awake MIS-TLIF offers benefits over general anesthesia, such as faster recovery, shorter hospital stays, and fewer side effects.

• Study limitations include small sample size and retrospective design; further research is needed.

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Outcomes and complications of minimally invasive transforaminal lumbar interbody fusion in the elderly: a systematic review and meta-analysis

J Neurosurg Spine 36:741–752, 2022

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may be used to treat degenerative spinal pathologies while reducing risks associated with open procedures. As an increasing number of lumbar fusions are performed in the aging United States population, MIS-TLIF has been widely adopted into clinical practice in recent years. However, its complication rate and functional outcomes in elderly patients remain poorly characterized. The objective of this study was to assess complication rates and functional outcomes in elderly patients (≥ 65 years old) undergoing MIS-TLIF.

METHODS The PubMed, Embase, and Scopus databases were searched for relevant records in accordance with the PRISMA guidelines. Inclusion criteria were peer-reviewed original research; English language; full text available; use of MIS-TLIF; and an elderly cohort of at least 5 patients. Risk of bias was assessed using the ROBINS-I (Risk of Bias in Nonrandomized Studies—of Interventions) tool. Pooled complication rates were calculated for elderly patients, with subgroup analyses performed for single versus multiple-level fusions. Complication rates in elderly compared to nonelderly patients were also assessed. Postoperative changes in patient-reported outcomes, including Oswestry Disability Index (ODI) and visual analog scale (VAS) back pain (BP) and leg pain (LP) scores, were calculated.

RESULTS Twelve studies were included in the final analysis. Compared to nonelderly patients, MIS-TLIF in elderly patients resulted in significantly higher rates of major (OR 2.15, 95% CI 1.07–4.34) and minor (OR 2.20, 95% CI 1.22–3.95) complications. The pooled major complication rate in elderly patients was 0.05 (95% CI 0.03–0.08) and the pooled minor complication rate was 0.20 (95% CI 0.13–0.30). Single-level MIS-TLIF had lower major and minor complication rates than multilevel MIS-TLIF, although not reaching significance. At a minimum follow-up of 6 months, the postoperative change in ODI (−30.70, 95% CI −41.84 to −19.55), VAS-BP (−3.87, 95% CI −4.97 to −2.77), and VAS-LP (−5.11, 95% CI −6.69 to −3.53) in elderly patients all exceeded the respective minimum clinically important difference. The pooled rate of fusion was 0.86 (95% CI 0.80–0.90).

CONCLUSIONS MIS-TLIF in elderly patients results in a high rate of fusion and significant improvement of patientreported outcomes, but has significantly higher complication rates than in nonelderly patients. Limitations of this study include heterogeneity in the definition of elderly and limited reporting of risk factors among included studies. Further study of the impact of complications and the factors predisposing elderly patients to poor outcomes is needed.

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Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion With Expandable Lordotic Devices

Neurosurgery, Volume 86, Issue 2, February 2020, Pages E147–E155

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a well-accepted procedure for the treatment of degenerative lumbar disease. However, its ability to restore lumbar lordosis has been limited. Development of expandable lordotic interbody devices has challenged this limitation, furthering the scope ofminimally invasive surgery.

OBJECTIVE: To evaluate the radiographic and clinical effects of expandable lordotic interbody devices placed through an MIS-TLIF approach.

METHODS: We conducted a retrospective review of 32 1-level and 18 2-level MIS-TLIFs performed using lordotic expandable interbody devices. Lumbar radiographic measurements, Oswestry Disability Index scores (ODI), and Visual Analogue Scale scores (VAS)were obtained at preoperative, 6 wk follow up, and last follow up time points. Last follow up occurred at a mean of 11.5 ± 7.6 mo (mean ± SD).

RESULTS: At 6-wk follow-up, segmental lordosis, disc height, and foraminal height increased by an average of 3.4◦, 6.4 mm, and 4.4 mm, respectively. Only the 2-level group showed a significant increase in lumbar lordosis of 5.8◦. No significant changes occurred in sacral slope, pelvic tilt, or pelvic incidence. Average ODI and VAS decreased by −12.0 and −4.5, respectively. Postoperative lumbar lordosis inversely correlated with preoperative lordosis in patients with an initial Pelvic Incidence to Lumbar Lordosis mismatch (PI-LL) of >10◦, (r=−0.5, P = .009).

CONCLUSION: When applied across 2-levels, MIS-TLIF using expandable lordotic interbody devices produced a significant increase in lumbar lordosis. Preoperative lumbar lordosis was found to be a predictor of postoperative lumbar lordotic change in patients with sagittal imbalance.

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Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Banana-Shaped and Straight Cages: Radiological and Clinical Results from a Prospective Randomized Clinical Trial

Neurosurgery 82:289–298, 2018

In minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), cage type and position play important roles in fusion achievement and sagittal alignment correction. However, no prospective randomized comparison of the results using different types of cage has been reported to date.

OBJECTIVE: To compare the radiological and clinical outcomes of unilateral MIS-TLIF using 2 types of cage.

METHODS: All candidates for single-level MIS-TLIF were randomized into banana-shaped cage and straight-cage groups. Plain radiographs and computed tomography scans were used for assessment of cage positions, fusion status, disc height, segmental lordotic angle, cage subsidence, and pelvic parameters. Clinical outcome was assessed using visual analog scale and Oswestry Disability Index scores.

RESULTS: Forty-four and 40 consecutive patients were operated on using banana-shaped and straight cages, respectively. Cage position was more anterior and lateral in the straightcage group and more medial and posterior in the banana-shaped cage group. Solid fusion was achieved in 95.2% and 96.6% of the 2 groups, respectively, at 12 mo. The change in disc height and segmental lordotic angle postoperatively was significantly greater in the banana-shaped cage group. The incidence of subsidence during follow-up was significantly higher in the banana-shaped cage group (P<.04). Clinically, the visual analog scale and Oswestry Disability Index scores decreased significantly after surgery in both groups, with no significant difference between the groups.

CONCLUSION: Our preliminary outcomes suggest that the subsidence rate may be higher using banana-shaped cages in MIS-TLIF, possibly due to their more medial final position.

 

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Minimally Invasive Transforaminal Lumbar Interbody Fusion Versus Percutaneous Endoscopic Lumbar Discectomy: Revision Surgery for Recurrent Herniation After Microendoscopic Discectomy

WORLD NEUROSURGERY 99: 89-95, 2017

Most patients with recurrence of microendoscopic discectomy (MED) need to receive revision surgery. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and percutaneous endoscopic lumbar discectomy (PELD) are common operative methods for MED recurrence, but no study has been made to compare the clinical outcomes of these 2 surgical methods as revision surgery for MED recurrence.

METHODS: A total of 105 patients who underwent either MIS-TLIF (58 patients) or PELD (47 patients) for revision of MED recurrence were included in this study. Perioperative outcomes (operation time, blood loss, and hospital stay), total cost, pain and functional scores (visual analog scale, Oswestry Disability Index, 12-item short form health survey) with a 12-month follow-up visit and review of complications and recurrence within 12 months postoperatively were recorded and assessed.

RESULTS: No significant difference of clinical outcome over time was observed between these 2 approaches. Compared with MIS-TLIF, PELD was associated with greater satisfaction in the early stage after surgery; this effect was equalized after 3 months postoperatively. PELD brought advantages in terms of shorter operation time, shorter hospital stay, less blood loss, and lower total cost compared with MIS-TLIF; however, PELD was also associated with a higher recurrence rate than MIS-TLIF.

CONCLUSIONS: Neither of these 2 surgical methods gave a clear advantage in long-term pain or function scores. Compared with MIS-TLIF, PELD could lead to a better perioperative result and less cost; however, the higher recurrence rate could not be ignored. Taking these characteristics into consideration was instrumental in pursuing personalized treatment for MED recurrence.

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