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Department of Neurosurgery, Oakland University William Beaumont School of Medicine findings published in the February online issue of Spine shows that patients who have a low back surgery called minimally invasive transforaminal lumbar interbody fusion (MITLIF), end up better off in many ways than patients who have more invasive surgery to alleviate debilitating pain.

Lumbar fusion serves to eliminate abnormal motion and instability while maintaining load-bearing capacity and proper alignment to provide symptomatic treatment for spinal instability, stenosis, spondylolisthesis, and symptomatic degenerative disc disease.1 During the past few decades there has been a dramatic increase in the rates of lumbar fusion procedures in the United States.

For many surgical procedures, the method of choice is shifting from traditional open surgery to minimally invasive techniques. Postoperative histological and imaging studies have demonstrated that conventional open techniques are associated with increased scar tissue formation, significant muscle stripping, and muscle retraction which adversely affect outcomes, and increase reoperation rates. Minimally invasive techniques are performed via a muscle-dilating approach that helps to preserve paraspinal muscular anatomy and bone architecture, and have been shown to diminish iatrogenic soft-tissue injury significantly. Reasons for widespread transition to minimally invasive spine (MIS) techniques include decreased postoperative pain, decreased intraoperative blood loss, shorter postoperative hospital stay, faster return to normal activity, and reduced reoperation rates.

Use of minimally invasive fusion techniques in lieu of traditional open fusion techniques remains a crucible of debate as long-term prospective outcomes in patients undergoing minimally invasive spinal fusion for debilitating back pain has not been well studied. This study was designed to contribute evidence to this debate by reporting long-term, prospectively collected outcomes on 1 of the largest currently available series of minimally invasive transforaminal lumbar interbody fusion (MITLIF) with a minimum follow-up of 24 months, and to determine if adjacent level pathology (ALP) is reduced by preservation of the normal anatomical integrity of the spin

The Beaumont study, led by Dr. Perez-Cruet, found that minimally invasive procedures with smaller incisions can reduce chronic low back pain, hospital stays, complications and scarring. It also can lower costs and infection rates compared with more invasive, open procedures. The seven-year study looked at 304 patients who received the minimally invasive procedure. There were 120 men and 184 women with a mean age of 62.4 years, ranging from 19 to 93 years.

The article concluded that the “MITLIF approach seems to provide both short- and long-term statistically significant outcome improvements in patients experiencing debilitating low back pain. In addition, long-term benefits observed in this study include a reduced rate of adjacent segment disease requiring reoperation while providing high rates of fusion and a low rate of complications. From a clinical prospective these patients show an extremely high rate of satisfaction in the treatment of their chronic back pain disorders. In fact, the majority of these patients are completely pain free and have returned to work or activities of daily living full time. The MITLIF procedure is a highly cost-effective approach for addressing a costly and debilitating medical condition.”