Related Experiment Video
Updated: Mar 28, 2026
Novel Mini-open Transforaminal Lumbar Interbody Fusion
Published on: June 6, 2025
Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review
Branko Skovrlj1, Patrick Belton1, Hekmat Zarzour1
1Branko Skovrlj, Hekmat Zarzour, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
Aim:
To compare minimally invasive (MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion (TLIF) surgeries with respect to length of surgery, estimated blood loss (EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay (LOS).
Methods:
A systematic review of previously published studies accessible through PubMed was performed. Only articles in English journals or published with English language translations were included. Level of evidence of the selected articles was assessed. Statistical data was calculated with analysis of variance with P < 0.05 considered statistically significant.
Results:
A total of 11 pertinent laminectomy studies, 20 direct lateral studies, and 27 TLIF studies were found. For laminectomy, MIS techniques resulted in a significantly longer length of surgery (177.5 min vs 129.0 min, P = 0.04), shorter LOS (4.3 d vs 5.3 d, P = 0.01) and less perioperative pain (visual analog scale: 16 ± 17 vs 34 ± 31, P = 0.04). There is evidence of decreased narcotic use for MIS patients (postoperative intravenous morphine use: 9.3 mg vs 42.8 mg), however this difference is of unknown significance. Direct lateral approaches have insufficient comparative data to establish relative perioperative outcomes. MIS TLIF had superior EBL (352 mL vs 580 mL, P < 0.0001) and LOS (7.7 d vs 10.4 d, P < 0.0001) and limited data to suggest lower perioperative pain.
Conclusion:
Based on perioperative outcomes data, MIS approach is superior to open approach for TLIF. For laminectomy, MIS and open approaches can be chosen based on surgeon preference. For lateral approaches, there is insufficient evidence to find non-inferior perioperative outcomes at this time.
Insights
Minimally invasive (MIS) surgery shows benefits for transforaminal lumbar interbody fusion (TLIF), with less blood loss and shorter hospital stays. For lumbar laminectomy, both MIS and open techniques are viable options based on surgeon preference.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Minimally Invasive Procedures
Background:
- Spinal fusion and laminectomy procedures are common treatments for various spinal conditions.
- Minimally invasive surgery (MIS) techniques have emerged as alternatives to traditional open surgical approaches.
- Comparing the perioperative outcomes of MIS versus open techniques is crucial for optimizing patient care.
Purpose of the Study:
- To systematically compare minimally invasive (MIS) and open surgical techniques for lumbar laminectomy, direct lateral, and transforaminal lumbar interbody fusion (TLIF).
- To evaluate key perioperative outcomes including surgical duration, blood loss, complications, and length of stay.
Main Methods:
- A systematic review of English-language studies was conducted using PubMed.
- Level of evidence for selected articles was assessed.
- Statistical analysis, including analysis of variance, was performed with a significance level of P < 0.05.
Main Results:
- For lumbar laminectomy, MIS techniques showed longer surgery times but shorter hospital stays and reduced postoperative pain compared to open procedures.
- Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) demonstrated significantly lower estimated blood loss and shorter length of stay than open TLIF.
- Insufficient comparative data exists for direct lateral approaches to establish definitive perioperative outcome differences.
Conclusions:
- The minimally invasive (MIS) approach is superior to the open approach for transforaminal lumbar interbody fusion (TLIF) based on perioperative outcomes.
- For lumbar laminectomy, both MIS and open approaches can be selected based on surgeon preference.
- Current evidence is insufficient to conclude non-inferior perioperative outcomes for lateral approaches using MIS techniques.
