Minimally invasive transforaminal lumbar interbody fusion with ipsilateral pedicle screw and contralateral facet screw fixation

Object. The purpose of this study was to introduce a minimally invasive transforaminal lumbar interbody fusion (TLIF) technique that involves ipsilateral pedicle screw (PS) and contralateral facet screw (FS) fixation. Methods. Eight men and 15 women (mean age 59.5 years, range 48-68) underwent the aforementioned TLIF procedure for degenerative spondylolisthesis and uni- or bilateral radiculopathy. Twenty-two patients underwent one-level fusion and one patient two-level fusion (L4-S1). In all cases the various procedures were undertaken via one small incision. There were no intraoperative complications. The mean estimated blood loss (EBL) was 310 ml, and the mean operative time was 150 minutes in cases of one-level fusion. The follow-up period ranged from 13 to 28 months (mean 19 months). The mean Numeric Rating Scale score reflected improvement-reductions from 7.5 (back pain) and 7.4 (leg pain) to 2.3 and 0.7, respectively (p < 0.0001). The mean Oswestry Disability Index (ODI) scores also reflected improved status (ODI of 33.1 before the surgery to 7.6 after the surgery; p < 0.0001). Examination indicated that 22 of 24 fusion sites exhibited osseous union. At the last follow-up examination, satisfactory outcomes were observed in 21 out of 23 patients. Conclusions. The TLIF with ipsilateral PS and contralateral FS fixation has the advantages over the conventional TLIF of reduced EBL and diminished soft-tissue injury.