From the Guidelines
Minimally invasive spinal fusion is preferred over open surgery due to its association with less blood loss, shorter hospital stay, and slightly less disability, as evidenced by the most recent and highest quality study 1. The advantages of minimally invasive spinal fusion over open surgery include:
- Smaller incisions, typically less than 2 inches long, compared to the 5-6 inch incisions required for open procedures
- Reduced blood loss, with studies showing less blood loss and longer fluoroscopy time with the minimally invasive approach 1
- Decreased muscle damage, leading to less postoperative inflammation and scarring
- Shorter hospital stays, with patients often experiencing hospital stays of 1-3 days versus 3-7 days for open surgery
- Faster recovery times, with many patients returning to normal activities within 4-6 weeks rather than 3-6 months
- Less postoperative pain, with pain management typically including a multimodal approach with medications like NSAIDs, muscle relaxants, and limited opioids The reduced tissue trauma in MIS procedures also results in lower infection rates and decreased risk of complications like excessive scarring and adjacent segment disease. However, it's worth noting that the evidence is not entirely consistent, and some studies have reported discordant findings, but the most recent and highest quality study 1 supports the use of minimally invasive spinal fusion over open surgery. Additionally, the principles of minimally invasive surgery have been shown to be beneficial in other fields, such as abdominal surgery, with laparoscopic liver resection being associated with improved early postoperative outcomes, including reduced morbidity, blood loss, length of hospital stay, and perioperative mortality compared to open surgery 1.
From the Research
Advantages of Minimally Invasive Spinal Fusion
The advantages of minimally invasive (MIS) spinal fusion over open surgery include:
- Reduced blood loss: Studies have shown that MIS spinal fusion results in significantly less blood loss compared to open surgery 2, 3, 4.
- Less postoperative pain: MIS spinal fusion has been associated with less postoperative pain and faster recovery times 2, 5, 4.
- Shorter hospital stays: Patients who undergo MIS spinal fusion tend to have shorter hospital stays compared to those who undergo open surgery 5, 3, 4.
- Lower infection rates: MIS spinal fusion may be associated with lower infection rates due to smaller incisions and less tissue trauma 5.
- Comparable clinical outcomes: Long-term clinical outcomes of MIS spinal fusion appear to be comparable to those of open fusion, with both techniques achieving high fusion rates and significant improvements in pain and function 5.
Specific Benefits of MIS Transforaminal Lumbar Interbody Fusion (TLIF)
MIS TLIF has been shown to have specific benefits, including:
- Improved visual analog scale (VAS) scores for leg pain and Oswestry disability index (ODI) scores 2.
- Reduced blood loss and shorter hospital stays compared to open TLIF 4.
- Better functional outcomes based on Oswestry disability index, Modified NASS score, and RAND 36-item Health Survey 1.0 score 4.
Considerations and Limitations
While MIS spinal fusion has several advantages, there are also some considerations and limitations to be aware of, including:
- Longer surgical times: MIS spinal fusion may require longer surgical times due to the technical complexity of the procedure 3, 6.
- Steeper learning curve: Surgeons may require additional training and experience to become proficient in MIS spinal fusion techniques 5.
- Higher initial costs: While MIS spinal fusion may offer long-term cost savings, the initial costs of the procedure may be higher due to the specialized equipment and training required 5.