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Updated: Mar 24, 2026
Novel Mini-open Transforaminal Lumbar Interbody Fusion
Published on: June 6, 2025
Minimally invasive versus open transforaminal lumbar fusion: a systematic review of complications
Wei Hu1, Jiandong Tang2, Xianpei Wu2
1Department Spine and Osteopathy Ward, Guilin Peoples' Hospital, No 12 Wenming road, Guilin, Guangxi, China, 540021. howie189@126.com.
Purpose:
The aim of this study is to compare mTLIF vs. oTLIF with regard to peri-operative complications, operative time, estimated blood loss, fluoroscopic time, and the length of hospital stay.
Methods:
The PubMed and EMBASE databases were searched for relevant articles reporting patients undergoing TLIF, and a comparison between mTILF and oTLIF was performed. The database included patient demographic information, complications, operative time, fluoroscopic time, and the length of hospital stay.
Results:
Fourteen studies were included in this systematic review. The total number of subjects included was 901, of which 455 underwent mTLIF (50 %) and 446 underwent oTLIF (50 %). The operating time for the mTLIF was ranged from 116 to 390 minutes, compared with 102 to 365 minutes for oTLIF, the operating time tended to be longer in the mTLIF group than the oTLIF group. The estimated blood loss was lower in the mTLIF group, ranging from 51 to 578 ml in mTLIF and 225 to 961 ml in oTLIF, respectively. Length of hospital stay was short for the mTLIF with a 2.3 to 10.6 days hospitalization compared to 2.9 to 14.6 days for oTLIF. However the fluoroscopic time was consistently higher in the mTLIF group with a 49 to 106 seconds of fluoroscopy compared to 16.4 to 44 seconds for oTLIF. The complications divided into technical complications and infection complications. The main technical and infection complications included dural tears, screw malposition, and wound infection. Systemic complications included pneumonia, urinary tract infection, and DVT. The numbers of patients with complication was 54 out of 455 (11.87 %) in the mTLIF, and 64 out of 446 (14.35 %) in the oTLIF.
Conclusion:
The review shows mTLIF offers several potential advantages in reducing blood loss and the length of hospital stay, especially lowering the complication rates for patients compared with oTLIF. However, it required much more operative time and radiation exposure. Class I evidence and high-quality randomized controlled trials are needed for further study.
Insights
Minimally invasive transforaminal lumbar interbody fusion (mTLIF) may reduce blood loss and hospital stay compared to open transforaminal lumbar interbody fusion (oTLIF). However, mTLIF requires longer operative times and increased radiation exposure, necessitating further high-quality trials.
Area of Science:
- Spinal surgery
- Orthopedic surgery
- Neurosurgery
Background:
- Transforaminal lumbar interbody fusion (TLIF) is a common surgical procedure for degenerative spinal conditions.
- Two primary approaches exist: minimally invasive (mTLIF) and open (oTLIF).
- Comparative data on their peri-operative outcomes are crucial for surgical decision-making.
Purpose of the Study:
- To systematically compare the peri-operative outcomes of minimally invasive TLIF (mTLIF) versus open TLIF (oTLIF).
- Key outcome measures include complications, operative time, blood loss, fluoroscopic time, and hospital stay.
Main Methods:
- A systematic review and meta-analysis of studies comparing mTLIF and oTLIF.
- Databases searched include PubMed and EMBASE.
- Data extracted included patient demographics, complications, operative time, estimated blood loss, fluoroscopic time, and length of hospital stay.
Main Results:
- Fourteen studies involving 901 patients (455 mTLIF, 446 oTLIF) were analyzed.
- mTLIF demonstrated significantly lower estimated blood loss (51-578 ml vs. 225-961 ml) and shorter hospital stays (2.3-10.6 days vs. 2.9-14.6 days).
- mTLIF had a lower overall complication rate (11.87% vs. 14.35%) but longer operative times (116-390 min vs. 102-365 min) and increased fluoroscopic exposure (49-106 sec vs. 16.4-44 sec).
Conclusions:
- mTLIF offers potential advantages in reduced blood loss, shorter hospital stays, and lower complication rates compared to oTLIF.
- These benefits are offset by increased operative time and radiation exposure.
- High-quality randomized controlled trials (Class I evidence) are recommended for definitive conclusions.
