Minimally invasive lumbar transforaminal interbody fusion (MIS TLIF) has become the most commonly performed lumbar fusion procedure. There are multiple variables such as bone graft properties, use of rhBMP (recombinant human bone morphogenic protein), interbody cage properties, image guidance techniques, etc., that may impact the outcomes and fusion rates. Radiation exposure to the patient as well as to the operating team is an important concern. The minimally invasive anterior approaches for lumbar fusion with ability to insert larger cages and achieve better sagittal correction have added another option in management of lumbar degenerative deformities. A literature review of recent studies and systematic reviews on different aspects impacting the outcomes of MIS TLIF has been done to define the present status of the procedure in this narrative review. Iliac crest bone graft can help achieve very good fusion rate without significantly increasing the morbidity. RhBMP is most potent enhancer of fusion and the adverse effects can be avoided by surgical technique and using lower dose. The use of navigation techniques has reduced the radiation exposure to patient and the surgeons but the benefit seems to be significant only in long segment fusions.
Keywords: ALIF, Anterior lumbar interbody fusion; Bone graft substitutes; DBM, Demineralised Bone Matrix; JOABPEQ, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire; LLIF, Lateral lumbar interbody fusion; MIISA, Minimally Invasive Interbody Selection Algorithm; MIS TLIF; MIS TLIF, Minimally invasive transforaminal interbody fusion; Minimally invasive lumbar interbody fusion; Navigation assisted lumbar fusion; OLIF, Oblique lumbar interbody fusion; SiCaP, Silicate-substituted Calcium Phosphate; Transforaminal interbody fusion; XLIF, Extreme lateral lumbar interbody fusion; rhBMP, recombinant human bone morphogenic protein; β-TCP, β-Tricalcium Phosphate.
© 2021 Delhi Orthopedic Association. All rights reserved.