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Updated: May 31, 2026
Novel Mini-open Transforaminal Lumbar Interbody Fusion
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Comparison of postoperative values for C-reactive protein in minimally invasive and open lumbar spinal fusion surgery
1Department of Neurosurgery, Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, Bronx, NY, USA.
Background:
A major purported benefit of minimally-invasive spinal surgery (MIS) technique is less disruption of paraspinal soft tissues, but there is little quantifiable evidence of this in medical literature. Postoperative C-reactive protein (CRP) levels been shown to become more significantly elevated with larger surgical procedures, and this may allow for more measurable appreciation of any benefits of MIS verses open spinal surgery.
Methods:
CRP values were measured prior to and at multiple time points following surgery in patients undergoing posterior spinal fusion using both open and minimally invasive techniques.
Results:
Peak postoperative CRP was significantly lower in the 35 single-level minimally invasive procedures compared with the 11 single-level open procedures (13.5 vs. 21.3, P <0.01) and lower in the 12 two-level minimally invasive surgeries compared with 16 two-level open procedures (20.5 vs. 31.8, P <0.01).
Conclusions:
MIS lumbar fusion is associated with a lower peak in postoperative CRP compared with open surgery. This appears to support the notion that minimally invasive spine surgery technique leads to a measurable reduction in paraspinal soft tissue destruction mediated inflammation in the immediate postoperative period.
Insights
Minimally-invasive spine surgery (MIS) shows lower postoperative C-reactive protein (CRP) levels than open surgery. This suggests MIS reduces inflammation and soft tissue damage during lumbar fusion.
Area of Science:
- Spinal surgery techniques
- Inflammatory markers in surgery
Background:
- Minimally-invasive spinal surgery (MIS) is thought to cause less soft tissue disruption than open surgery, but evidence is limited.
- Postoperative C-reactive protein (CRP) elevation correlates with surgical invasiveness, offering a potential metric to compare MIS and open spinal surgery outcomes.
Purpose of the Study:
- To quantify the difference in postoperative C-reactive protein (CRP) levels between minimally-invasive spinal surgery (MIS) and open spinal surgery.
- To assess if MIS leads to reduced inflammation compared to open procedures.
Main Methods:
- Patients undergoing posterior spinal fusion were included.
- C-reactive protein (CRP) levels were measured before and at various times after surgery.
- Surgical groups included both minimally-invasive and open techniques for single and two-level fusions.
Main Results:
- Peak postoperative CRP was significantly lower in single-level MIS (13.5) versus open procedures (21.3, P <0.01).
- Peak postoperative CRP was also significantly lower in two-level MIS (20.5) versus open procedures (31.8, P <0.01).
Conclusions:
- Minimally-invasive lumbar fusion is associated with a lower peak postoperative CRP compared to open surgery.
- These findings support the hypothesis that MIS reduces paraspinal soft tissue inflammation in the early postoperative period.
