Very few studies reported the duration and radiation exposure res

Very few studies reported the duration and radiation exposure resulting from X-ray selleck and fluoroscopy. Authors who did report this data found that MI-TLIF had greater duration of radiation exposure for patients undergoing the procedure [3, 5, 7]. Due to the relative recent adoption of MI-TLIF use, the long-term effects of increased radiation exposure have not been evaluated. The development of 2D computer assisted fluoroscopy systems as well as the O-arm is a modern means to decrease this exposure risk. Further, careful attention to radiation safety in the operating room is critical. 4.2. Studies of Note Following data collection and the literature review, it is clear that there is a paucity of data comparing MI-TLIF and open TLIF. To our knowledge, there remains no high-class studies that directly compare these two techniques.

However, smaller studies, both prospective and retrospective in nature, have shown promise in regards to novel MI techniques for TLIF. Scheufler et al. compared percutaneous transforaminal lumbar interbody fixation (pTLIF) with mini-open transforaminal lumbar interbody fixation (oTLIF) while utilizing the Wiltse method [10]. They found at 8 month and 16 month follow-up, overall clinical outcome did not differ between the two techniques. However, in terms of pain following the operation, pTLIF resulted in significantly lower levels of pain (P < 0.01). Though the study showed no decreased advantages due to the percutaneous approach, a longer prospective study would be needed to further discern the success and functionality of each multilevel fusion.

In a study examining 42 patients with mean follow-up time of 29 months, Dhall et al. compared mini-open and open TLIF [4]. The authors found that mean estimated blood loss for mini-open (194mL) was significantly lower (P < 0.01) than the open-group (505mL). The length of stay was decreased for mini-open patients by on average, 2.5 days (P < 0.01). However, there were complications of neurologic nature in 2 patients, while 2 other patients required further revision. All 42 patients displayed fusion, and the authors felt that the mini-open technique was a possible substitute to open TLIF. Schwender et al. performed one of the earlier studies (2001-2002) on 49 patients who had MI-TLIF. Majority of patients in the study either had degenerative disc disease with herniated nucleus pulposus (HNP) or spondylolisthesis [14].

45 of 49 cases were completed at the L4-L5 or L5-S1 levels. Mean operative times were approximately 240 minutes, approximate blood loss was 140mL, and hospital stays averaged 1.9 days. Complications were limited to four patients, two of which required screw repositioning while two others developed radiculopathy following Carfilzomib the procedure. VAPS changed on average from 7.2 to 2.

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