International Orthopaedics

, Volume 42, Issue 12, pp 2835–2842 | Cite as

Comparison of bilateral versus unilateral decompression incision of minimally invasive transforaminal lumbar interbody fusion in two-level degenerative lumbar diseases

  • Yongzhao Zhao
  • Yanjie Zhu
  • Hailong Zhang
  • Chuanfeng Wang
  • Shisheng He
  • Guangfei GuEmail author
Original Paper



To compare the efficacy and safety of two different surgical incisions for minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the management of two-level degenerative lumbar diseases.


We conducted a retrospective study of 129 patients, who underwent two-level MIS-TLIF for degenerative lumbar diseases from September 2014 to December 2015. Sixty-two patients underwent MIS-TLIF with unilateral long decompression incision (group A) and 67 patients underwent MIS-TLIF with bilateral short decompression incision (group B). Demographics and peri-operative clinical data were collected from medical records. Radiographic fusion, visual analog scale for leg pain (VAS-LP), back pain (VAS-BP), the Oswestry Disability Index (ODI), and MacNab satisfaction were compared between two groups.


Patients in group A experienced significantly longer operative time (P = 0.019), more estimated blood loss (P = 0.002), and radiation exposure (P < 0.001) than those in group B. However, no statistical differences were detected between two groups in blood transfusion (P = 0.845) or hospital stay (P = 0.690). Besides, VAS-BP, VAS-LP, and ODI significantly improved in both groups after the surgery, but no significant differences were observed between two groups pre-operatively, three day post-operatively, or at the last follow-up. Moreover, there were no distinct differences between two groups in total complication rate (P = 0.653), fusion rate (P = 0.822), or MacNab satisfaction (P = 1.000) at the last follow-up.


In two-level degenerative lumbar diseases, based on the bilateral decompression via unilateral approach technique, MIS-TLIF with bilateral short decompression incision could significantly reduce radiation exposure, shorten operative time, decrease blood loss, and achieve comparable clinical outcomes when compared to unilateral long decompression incision.


MIS-TLIF Two-level degenerative lumbar diseases Bilateral incision Unilateral incision 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Kaiser MG, Eck JC, Groff MW, Ghogawala Z, Watters WC 3rd, Dailey AT, Resnick DK, Choudhri TF, Sharan A, Wang JC, Dhall SS, Mummaneni PV (2014) Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 17: bone growth stimulators as an adjunct for lumbar fusion. J Neurosurg Spine 21(1):133–139. CrossRefPubMedGoogle Scholar
  2. 2.
    Talia AJ, Wong ML, Lau HC, Kaye AH (2015) Comparison of the different surgical approaches for lumbar interbody fusion. J Clin Neurosci 22(2):243–251. CrossRefPubMedGoogle Scholar
  3. 3.
    Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ (2015) Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg 1(1):2–18. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lee YC, Zotti MG, Osti OL (2016) Operative management of lumbar degenerative disc disease. Asian Spine J 10(4):801–819. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kwon B, Kim DH (2016) Lateral lumbar interbody fusion: indications, outcomes, and complications. J Am Acad Orthop Surg 24(2):96–105. CrossRefPubMedGoogle Scholar
  6. 6.
    Harms JGJD (1998) The unilateral transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol 6:88–89Google Scholar
  7. 7.
    Wong AP, Smith ZA, Stadler JA 3rd, Hu XY, Yan JZ, Li XF, Lee JH, Khoo LT (2014) Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF): surgical technique, long-term 4-year prospective outcomes, and complications compared with an open TLIF cohort. Neurosurg Clin N Am 25(2):279–304. CrossRefPubMedGoogle Scholar
  8. 8.
    Cole CD, McCall TD, Schmidt MH, Dailey AT (2009) Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches. Curr Rev Musculoskel Med 2(2):118–126. CrossRefGoogle Scholar
  9. 9.
    Foley KT, Holly LT, Schwender JD (2003) Minimally invasive lumbar fusion. Spine 28(15 Suppl):S26–S35. CrossRefPubMedGoogle Scholar
  10. 10.
    Wu MH, Dubey NK, Li YY, Lee CY, Cheng CC, Shi CS, Huang TJ (2017) Comparison of minimally invasive spine surgery using intraoperative computed tomography integrated navigation, fluoroscopy and conventional open surgery for lumbar spondylolisthesis: a prospective registry-based cohort study. Spine J.
  11. 11.
    Vazan M, Gempt J, Meyer B, Buchmann N, Ryang YM (2017) Minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a technical description and review of the literature. Acta Neurochir.
  12. 12.
    Gu G, Zhang H, Fan G, He S, Cai X, Shen X, Guan X, Zhou X (2014) Comparison of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease. Int Orthop 38(4):817–824. CrossRefPubMedGoogle Scholar
  13. 13.
    Schmitz-Feuerhake I, Busby C (2016) Genetic radiation risks: a neglected topic in the low dose debate. 31:e2016001. doi:
  14. 14.
    Yamashita K, Ikuma H, Tokashiki T, Maehara T, Nagamachi A, Takata Y, Sakai T, Higashino K, Sairyo K (2017) Radiation exposure to the hand of a spinal interventionalist during fluoroscopically guided procedures. Asian Spine J 11(1):75–81. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Lin JH, Chiang YH (2014) Unilateral approach for bilateral foramen decompression in minimally invasive transforaminal interbody fusion. World Neurosurg 82(5):891–896. CrossRefPubMedGoogle Scholar
  16. 16.
    Gu G, Zhang H, He S, Jia J, Fu Q, Zhou X (2013) Preoperative localization methods for minimally invasive surgery in lumbar spine: comparisons between a novel method and conventional methods. J Spinal Disord Tech 26(7):E277–E280. CrossRefPubMedGoogle Scholar
  17. 17.
    Orpen NM, Corner JA, Shetty RR, Marshall R (2010) Micro-decompression for lumbar spinal stenosis: the early outcome using a modified surgical technique. J Bone Joint Surg Br Vol 92(4):550–554. CrossRefGoogle Scholar
  18. 18.
    Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K (1995) Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine 20(12):1410–1418CrossRefPubMedGoogle Scholar
  19. 19.
    Shen X, Zhang H, Gu X, Gu G, Zhou X, He S (2014) Unilateral versus bilateral pedicle screw instrumentation for single-level minimally invasive transforaminal lumbar interbody fusion. J Clin Neurosci 21(9):1612–1616. CrossRefPubMedGoogle Scholar
  20. 20.
    Kang MS, Park JY, Kim KH, Kuh SU, Chin DK, Kim KS, Cho YE (2014) Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation: comparison between primary and revision surgery. Biomed Res Int 2014:919248. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Parker SL, Adogwa O, Witham TF, Aaronson OS, Cheng J, McGirt MJ (2011) Post-operative infection after minimally invasive versus open transforaminal lumbar interbody fusion (TLIF): literature review and cost analysis. Minim Invasive Neurosurg 54(1):33–37. CrossRefPubMedGoogle Scholar
  22. 22.
    Karikari IO, Isaacs RE (2010) Minimally invasive transforaminal lumbar interbody fusion: a review of techniques and outcomes. Spine 35(26 Suppl):S294–S301. CrossRefPubMedGoogle Scholar
  23. 23.
    Grelat M, Zairi F, Quidet M, Marinho P, Allaoui M, Assaker R (2015) Assessment of the surgeon radiation exposure during a minimally invasive TLIF: comparison between fluoroscopy and O-arm system. Neuro-Chirurgie 61(4):255–259. CrossRefPubMedGoogle Scholar
  24. 24.
    Fan G, Fu Q, Gu G, Zhang H, Guan X, Zhang L, Gu X, He S (2015) Radiation exposure to surgeon in minimally invasive transforaminal lumbar interbody fusion with novel spinal locators. J Spinal Disord Tech 28(3):E173–E180. CrossRefPubMedGoogle Scholar
  25. 25.
    Kim DY, Lee SH, Chung SK, Lee HY (2005) Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine 30(1):123–129CrossRefPubMedGoogle Scholar
  26. 26.
    Phan K, Rao PJ, Mobbs RJ (2015) Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: systematic review and meta-analysis of comparative studies. Clin Neurol Neurosurg 135:85–92. CrossRefPubMedGoogle Scholar
  27. 27.
    Gu G, Zhang H, He S, Cai X, Gu X, Jia J, Fu Q, Zhou X (2015) Percutaneous pedicle screw placement in the lumbar spine: a comparison study between the novel guidance system and the conventional fluoroscopy method. J Spinal Disord Tech 28(9):E522–E527. CrossRefPubMedGoogle Scholar
  28. 28.
    Rampersaud YR, Foley KT, Shen AC, Williams S, Solomito M (2000) Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine 25(20):2637–2645CrossRefPubMedGoogle Scholar
  29. 29.
    Choi WS, Oh CH, Ji GY, Shin SC, Lee JB, Park DH, Cho TH (2014) Spinal canal morphology and clinical outcomes of microsurgical bilateral decompression via a unilateral approach for lumbar spinal canal stenosis. Eur Spine J 23(5):991–998. CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Yongzhao Zhao
    • 1
  • Yanjie Zhu
    • 1
  • Hailong Zhang
    • 1
  • Chuanfeng Wang
    • 1
  • Shisheng He
    • 1
  • Guangfei Gu
    • 1
    Email author
  1. 1.Orthopedic Department, Shanghai Tenth People’s HospitalTongji University School of MedicineShanghaiChina

Personalised recommendations