Related Experiment Video
Updated: Sep 4, 2025
Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion
Published on: June 16, 2023
Surgical Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Surgical Microscope vs Surgical
Weerasak Singhatanadgige1,2, Hathaiphoom Chamadol1, Teerachat Tanasansomboon1,2
1Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Background:
Minimally invasive transforaminal interbody fusion (MIS-TLIF) is an effective procedure for lumbar spine diseases. The procedure can be done using a surgical microscope (SM) or surgical loupes (SL) magnification. However, there are no studies that compared outcomes between using these 2 magnifying devices in the MIS-TLIF procedure. The purpose of this study was to compare clinical outcomes, perioperative complications, and radiographic parameters of MIS-TLIF using SM compared with SL magnification.
Methods:
We included all patients undergoing 1-level MIS-TLIF between January 2017 and December 2019. Type of magnification (SM vs SL), operative time, blood loss, perioperative complications, cross-sectional area of the spinal canal, and fusion rates were analyzed. Clinical outcomes measurement using the visual analog scale (VAS) and Oswestry Disability Index (ODI) were compared between groups.
Results:
A total of 100 patients had underwent MIS-TLIF (SM group: 62; SL group: 38). Operative time (SM: 182.7 ± 41.5 vs SL: 165.6 ± 32.6 minutes, P = 0.043) was significantly shorter in the SL group, with a mean difference of 17.2 minutes and a 10.4% increase in operative time between SL and SM. Blood loss (SM: 187.4 ± 176.4 vs SL: 215.6 ± 99.4 mL, P = 0.36) was not different between groups, with a mean difference of 28.2 mL. Both the SM group and SL group demonstrated no significant differences in improvement from baseline in VAS back, VAS legs, ODI score, and cross-sectional area of the spinal canal. There was also no significant difference in complication rates and fusion rates between groups.
Conclusions:
Our study found no difference between intraoperative use of SL compared with SM in clinical outcomes through the 12-month follow-up timepoint. However, the use of SM resulted in an increased average operative time of 17 minutes compared with the SL group.
Clinical Relevance:
Intraoperative use of SM and SL magnification in MIS-TLIF provides similar outcomes except prolonged operative time in the SM group.
Insights
Minimally invasive transforaminal interbody fusion (MIS-TLIF) using surgical microscopes (SM) or surgical loupes (SL) yielded similar clinical outcomes. However, SM use was associated with a longer operative time compared to SL.
Area of Science:
- Spine surgery
- Minimally invasive procedures
- Surgical magnification techniques
Background:
- Minimally invasive transforaminal interbody fusion (MIS-TLIF) is a key procedure for lumbar spine conditions.
- Surgical magnification, using either surgical microscopes (SM) or surgical loupes (SL), is employed during MIS-TLIF.
- Comparative outcome data between SM and SL in MIS-TLIF are lacking.
Purpose of the Study:
- To compare clinical outcomes between SM and SL magnification in MIS-TLIF.
- To evaluate differences in perioperative complications and radiographic parameters.
- To determine the impact of magnification choice on patient recovery and surgical success.
Main Methods:
- A retrospective analysis of 100 patients undergoing 1-level MIS-TLIF between 2017 and 2019.
- Comparison of operative time, blood loss, and perioperative complications between SM and SL groups.
- Assessment of clinical outcomes (VAS, ODI) and radiographic parameters (spinal canal area, fusion rates).
Main Results:
- Operative time was significantly shorter with SL (165.6 ± 32.6 min) compared to SM (182.7 ± 41.5 min) (P=0.043).
- No significant differences were observed in blood loss, clinical outcomes (VAS, ODI), spinal canal area, or fusion rates between the SM and SL groups.
- Complication rates were similar between the two magnification groups.
Conclusions:
- Intraoperative use of SL magnification in MIS-TLIF offers comparable clinical outcomes to SM.
- SM magnification in MIS-TLIF is associated with a statistically significant increase in operative time.
- Both magnification methods provide similar safety profiles and radiographic success in MIS-TLIF procedures.
