Comparative analysis of short-term outcomes between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and traditional midline open transforaminal lumbar interbody fusion for single-level lumbar spinal stenosis

Abstract

Background: To compare the clinical efficacy of Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) versus Traditional Midline Open Transforaminal Lumbar Interbody Fusion (Open-TLIF) for Single-Level Lumbar Spinal Stenosis (LSS). Methods: From January 2020 to December 2023, 83 patients with single-level LSS were enrolled at our institution. Among them, 40 underwent MIS-TLIF (MIS-TLIF Group) and 43 received Open-TLIF (Open-TLIF Group). Surgical parameters including operative time, estimated blood loss, time to first ambulation, postoperative hospital stay, and intervertebral height were recorded. Clinical outcomes assessed preoperatively, at 1 month postoperatively, 3 months postoperatively, and final follow-up included: Visual Analog Scale (VAS) scores for low back pain and leg pain, and Oswestry Disability Index (ODI). Modified MacNab criteria were used to evaluate clinical efficacy at final follow-up. Result: All procedures were successfully completed. No statistically significant differences were observed in operative time or early complication rates between groups (P > 0.05). However, the MIS-TLIF group demonstrated significantly longer operative durations compared to Open-TLIF (P < 0.05), while the Open-TLIF group exhibited greater estimated blood loss, delayed time to first ambulation, and prolonged postoperative hospitalization versus MIS-TLIF (all P < 0.05). Both groups showed significant reductions in low back pain VAS, leg pain VAS, and ODI scores postoperatively versus preoperative baselines (all P < 0.05). Notably, the MIS-TLIF group achieved lower pain VAS and ODI scores at 1-month, 3-month, and final follow-up timepoints compared to Open-TLIF (all P < 0.05). According to modified MacNab criteria at final follow-up, both groups demonstrated excellent/good clinical outcomes without intergroup statistical significance (P > 0.05). Conclusion: Both MIS-TLIF and Open-TLIF yield favorable clinical outcomes for single-level lumbar spinal stenosis (LSS). MIS-TLIF offers distinct advantages including reduced surgical trauma and accelerated postoperative recovery, demonstrating benefits in terms of reduced EBL, shorter time to first ambulation, and shorter hospitalization.