Is Pedicle-Screw Internal Fixation With Two Small Incisions Superior to Traditional MI - TLIF With Four Incisions?...

There are many instruments and facilities designed to facilitate the procedure of minimally invasive spine surgery. However, those current instrumentation systems may increase the complexity to accomplish the procedure. Our department developed a specific two small incision surgery for MI-TLIF, and the benefits of this technique could control only one unilateral surgical incision for two-screw insertion, which the length of each wound was as small as 3.0-4.0 cm. In this retrospective study, we compared the intraoperative and postoperative results of novel two incisions technique and traditional four surgical incisions for patients with 1-level MI-TLIF treatment.

We retrospective recruited 80 consecutive patients who had degenerative spinal stenosis or spondylolisthesis and received primary 1-level MI-TLIF in single hospital from September 10, 2020, to October 19, 2023. The Wiltse approach for interbody fusion and a single-plane fluoroscopy-guided method to insert the pedicle screws were used. Patients were divided into two groups depending on different surgical techniques. Patient demographics, intraoperative and postoperative data were assessed. The Mann-Whitney U test or Fisher exact test were used to evaluate the data and a p value < 0.05 was considered significant in this study.

A total of 71 patients met the inclusion criteria in this study. The baseline data were similar between novel technique (n = 41, two incisions) and traditional MI-TLIF group (n = 30, four incisions). Among all intraoperative, postoperative and complication categories, the instrumentation time was the only item that showed significant difference, which is shorter in novel technique group (p = 0.034). The difference became more apparent in the obese group (BMI ≥ 27 kg/m ² , p = 0.01).

Although the novel technique could reduce the number of surgical incisions compared to traditional MI-TLIF, the intraoperative and postoperative results were similar to the traditional MI-TLIF. Hence the reduction in wound number and the total length of surgical wound does not have obvious benefits in 1-level MI-TLIF patients. However, the less surgical exposure may offer less surgical wounds complications for specific groups, which were immune-compromised, such as diabetics, chronic renal disease, or cancer patients, and the clinical follow-up of specific groups will be planned to perform in the future.