SURGICAL OUTCOMES AND RECOVERY IN CONVENTIONAL VERSUS MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION: A SINGLE-CENTER EXPERIENCE IN A MIDDLE-INCOME HEALTHCARE SYSTEM.

BACKGROUND

Minimally invasive transforaminal lumbar interbody fusion - TLIF (MIS-TLIF) may reduce perioperative morbidity compared with conventional open TLIF, but evidence from middle-income healthcare systems is limited.

AIM: To compare clinical outcomes, radiological fusion, and early postoperative recovery between open TLIF and MIS-TLIF.

METHODS

Forty-one patients undergoing one- to three-level TLIF for degenerative lumbar conditions were retrospectively analyzed (22 open, 19 MIS). Outcomes included operative time, blood loss, hospital stay, pain intensity (VAS), Oswestry Disability Index (ODI), radiation exposure, and fusion grade (Bridwell system).

RESULTS

MIS-TLIF was associated with shorter operative times (267±14 vs. 351±12 min), lower blood loss (107±4 vs. 331±25 mL), and shorter hospitalization (4.2±0.3 vs. 6.7±0.5 days; all P < 0.0001). Early pain recovery was faster (VAS on day 12: 1.3 vs. 2.2; P ≤ 0.0007). Functional improvement, assessed using the Oswestry Disability Index (ODI) at approximately 6 months postoperatively, paralleled these findings, decreasing from 85.63±5.18% to 10.27±2.66% in the open TLIF group, and from 85.47±6.21% to 6.10±2.70% in the MIS-TLIF group. Fusion rates were comparable, while fluoroscopic exposure was higher in MIS-TLIF (137.8±9.6 vs. 53.2±3.1 μGy). No complications occurred in MIS-TLIF; open TLIF had one revision for cage migration and one superficial wound infection.

CONCLUSIONS

MIS-TLIF provides superior perioperative outcomes and faster early pain recovery with comparable fusion rates. Increased radiation exposure remains a consideration. These findings support MIS-TLIF as an effective alternative to open TLIF in middle-income healthcare settings.