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Open vs. Minimally Invasive TLIF

Cath111CCath111 Posts: 3,702
edited 06/11/2012 - 8:39 AM in Back Surgery and Neck Surgery
Can anybody explain the difference between an open TLIF and a minimally invasive TLIF for me please?



  • Hi Cath, I'm not sure of all the differences but I know that I didn't have to give blood prior to my MI TLIF, in fact I barely lost any blood at all. My incision is only about 1.5" long and they did not have to cut through muscle. Supposedly the healing time is a lot shorter for MI's as well.
  • Did you read through the info on this site? It's a good article!


    If you are asking what is different besides the way the area is accessed, there isn't a lot of difference. The instrumentation is pretty much done in the same way, although obviously there is some hardware that cannot be used in MIS because it is simply too large. The surgeon uses an endoscope so he can see what he is doing on a television screen as opposed to actually opening up the space and being able to see what is going on. My only thought would be whether they can see other things (adjoining tissue) as well when doing MIS. I would assume they can only see a very limited area...but I do not know...just something I wonder about. The ONLY reason MIS is done is to avoid having to cut through muscle and other soft tissue -- However, one thing that is important to find out is if the surgeon uses a retractor once inside the skin. There is almost as much stress to the muscle as if it had been cut when using the retractor. Many so called "minimally invasive" surgeries really are not, except in how the surgical area is exposed. There is just as much trauma when pulling the tissue apart as if it were cut, or so I've read.

    Open surgeries are not necessarily more bloody. I've had two open spine surgeries and never gave blood ahead or needed any. The actual pain from the fusion is about the same. The bones are still being drilled, screws are still inserted, etc. The incision will heal faster because it is smaller, but the "inside healing" takes the same amount of time, whether open or MIS.

    So far the few studies that have been completed show no statistical difference in outcome, or patient satisfaction, but there isn't that much data yet.

    I think you just need to go with whatever your surgeon suggests and what he is most comfortable doing. My surgeon would not do MIS if any spondylolisthesis is present...but he tends to be on the conservative side. He does perform the surgery; it's not that he is not trained to do MIS -- 20 years ago he worked on the development of some of the instruments used in MIS and he performs it now, where appropriate.

    What specific info are you looking for?


    There is supposed to be a shorter time in the hospital,
  • is the size of the incision and how the muscles are treated. As noseovertail mentioned, the minimally invasive uses a much smaller incision and the muscles are basically just moved out of the way, whereas in a traditional "open" TLIF the muscles are cut and the incision is much larger. I had an open TLIF L4-S1 about 2 months ago and my incision was close to 9" long. But I didn't have to give blood either, and was only in the hospital for 3 days.
  • Noseovertail, Gwennie and AWalker, thank you so much for the info. I appreciate the time taken to reply - this is such a great group of people.

    I think you guys basically answered most of the questions I have in my mind but neglected to put in my post. I have too many questions to actually ask them all.

    I have little knowledge of the specifics of lumbar procedures and they seem to be pretty complicated and varied the more I research my upcoming surgery. I was told that I'm going to have a TLIF on L4/5, but may become a PLIF once they get in there and see exactly what's going on. I haven't been given any specifics because I haven't received my pre-surgical packet yet and it's not time to have my pre-surgical consult with my surgeon this far out.

    I've read a bunch of articles on this site and others as well, but some things I haven't found yet. Like recovery time vs. one or the other, time in the hospital, healing, hardware, etc. You've basically answered those for me.

    From what Gwennie said and the fact that it may be either a TLIF or PLIF depending on what they find tells me that it's probably going to be an open procedure. I'm lucky that I have so much confidence and trust in my surgeon and the entire spine clinic that I agree with everything he and his associates want me to do.

    If you boil it all down, I suppose I'm looking for anything regarding these procedures. Like most, I'm just trying to get a handle on what I might be facing during the surgery, the hospital stay and recovery.

    Thanks again for your help.
  • I started to write "you should be sure to..." but then changed my mind. I was going to say find out what hardware will be used, whether you will have a cage, what type of bone graft will be used, instrumentation, etc., but the average person probably does not ask these things. As a patient, you pick your doctor and then have enough trust that he will do the procedure that is right for your particular situation, body type, etc. If you had your heart set on a TLIF and your surgeon told you he was going to do a PLIF, would you change doctors? Probably not...

    However, if you liked two surgeons equally and couldn't decide...it could figure in the decision. I was going to use one surgeon until on the way out the door I thought to ask how he would do my one level fusion. He then proceeded to describe the "360" --that was the tipping point for me. I selected another surgeon that was planning a PLIF.

    I don't know if this surgery will be very similar to your cervical fusion, since I have not had one. Some people seem to think recovery is harder, and others say easier.

    I am probably having a 3 level PLIF in late Jan...I haven't quite decided yet. If I do, it will be with a different surgeon than did my first fusion. I think of him as more conservative than my first surgeon, but the recovery schedule he laid out for me was very much on the abbreviated side...like driving at 2-3 weeks. I was still practically comatose at 2 weeks with my first fusion...and that was just one level...so I do not believe what he told me.

    Do you know if you will be in a brace? Usually you are fitted ahead of the surgery if your doc requires one. My first doc didn't like them, but this one does...so I guess I'll have that to contend with. But I have one more appointment with a new doc the end of December. He does a lot of cutting edge stuff and he might have something else to recommend to me...so I am keeping an open mind.

    Anyway, just post whenever you think of a question. Too many of us have experience with lumbar fusion.
  • Cath 111,

    I have never had major surgery, this will be the first. I'm scheduled for a MI TLIF on Dec. 3rd. I
    did get 3 opinions, and probably would have sought more except the 3rd MD was my choice for a surgeon.

    Here is what I understand. I will have two incisions. MD showed length with his fingers, so I'd
    say about 1 inch each. I will have sutures, not staples. I am told muscle is "gone through". I think of it as "with the grain of the wood". It is my understanding that in open surgery, layers are cut including muscle and each layer has to be stitched. My surgeon's nurses are his surgical nurses. I talked with one at length who assured me
    the MI was the way to go. She had open spine surgery. I'm told there is no blood. I will not have a drain or brace. I will be gotten up to walk
    day of surgery. Hospital stay is one night. Surgery
    is 1 1/2 hours. This is to open up the vertebrate
    remove the disk, place a cage with BMP (maybe wrong
    initial's, I forgot them) pull spine back into position and secure with rods and screws. I have
    Grade 2 spondylolisthesis. Surgeon also said would
    be doing a laminectomy and remove a bone spur.
    I was told I would probably take pain meds for 6 wks.
    Surgeon said I could drive and return to work when I
    feel like it. He said he was had people return to work after 1 week, but typically it is 3-4 weeks.
    He said much depends on the reaction to the pain meds.

    Hope this helps. I'll post after surgery so you'll
    have more info.

    The biggest thing I have seen different by reading the posts is the hours of surgery.
  • Gwennie, with my ACDF, I was completely ignorant beforehand, but by the time I saw my surgeon for my first post-op visit, I had soaked up info like a sponge. So at that appt., I had him show me what hardware he'd put in my neck. So, thanks for the reminder to ask about the hardware. It's on my list.

    I've also heard some say it's a harder recovery than an ACDF, but others say it's easier. It might be a wash because my ACDF was a 3-lvl and my TLIF is just a 1-lvl. But really, I won't know until it happens.

    My surgeon said I'll be wearing a brace, but not for how long. He said that my surgery would be about 5 hours, so that's another hint that it's probably going to be an open procedure.

    What's holding up your decision whether to have your PLIF or not?

    Laughnsmile, thanks so much for the info you shared with me. I had asked my surgeon why he chose this particular procedure, and it's because I have severe stenosis and facet issues and he needs to fuse the facet joints and clean out the space where the bone is impinging on the nerves. He said this was the only surgery where he could get rid of all three of my symptoms: LBP, butt and hip pain, and pain going down both of my legs.

    What level(s) are you having done? I'll look forward to reading your post-op posts, so be sure to keep us updated.

    Thanks again fellow spineys, for all the info and help.

  • When did you have your surgery and what levels were fused?
  • Hi Gwennie,

    Had surgery in July, L5-S1 fused.

  • Hi Cath,

    It sounds like you have many of the issues I did. My OSS told me that TLIF works like a 360, since they can work 'across' the vertebra, clean out the gunk and do whatever else that's needed but w/out the need to have incisions done front & back. From how it was explained, the dilators used in MI procedures 'split' the muscle fibers along their natural divisions, there is trauma, but not as severe as in open procedures where muscles are stripped off the spine. The endoscope can be 'swiveled' so that the surgeon can work up & down the area as needed. The bone from my lammies was enough to use for the fusion. My surgery took over 4 hours, so you may still be a candidate for MI. Had surgery on Monday, released to home Wednesday. My OSS was very upfront regarding the level of pain post op, said I'd feel like a 'horse kicked me', I thought an elephant had. The worse pain for me post op was from muscle spasming, but w/ the right RX cocktail, I was pretty comfortable. My doc dosen't believe in bracing, told me blood loss is small so no need to store my own prior to surgery, sutures were self dissolving. Do you know what system your surgeon would use if you go the MI route, I don't know if you looked at this article on SH about the types that can be used:


    Hope this helps.
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