Evolution of Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Pre-, Partial-, and Full-Navigation in a 15-Year Cohort.

Abstract

Retrospective observation. To analyze the evolution and impact of navigation technology in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). While navigated pedicle screw placement improves accuracy, reduces blood loss, and decreases radiation exposure for surgeons, longer operation times have also been reported. All patients who underwent MIS-TLIF between 2008 and 2022 were included. Physiological measures, including surgical disc levels, operation time, estimated blood loss, and the incidence of screw revision due to malposition, debridement, surgery for adjacent segment disease, or implant failure, were compared. Patients were divided into 2 groups: "no navigation" (fluoroscopic guidance) and "navigation" (from navigated screw placement to full navigation including decompression and interbody grafting, eliminating fluoroscopy). Year groups were further analyzed: 2008-2011 (no navigation), 2012-2015 (no navigation), 2016-2019 (navigation for screw placement), and 2020-2022 (total navigation). A total of 823 patients (427 "no navigation" vs. 396 "navigation") were included. In 1-disc-level non-navigated MIS-TLIF, operation time decreased across the years [266.0±63.9 (2008-2011) vs. 215.5±57.3 (2012-2015) vs. 191.7±41.8 (2016-2019) minutes, P <0.001]. For navigated screw placement (2016-2019), navigation prolonged the duration of 1-disc-level MIS-TLIF (241.7±106.2 vs. 191.7±41.8 min, P <0.001) but not in 2-disc-level MIS-TLIF (293.1±74.1 vs. 302.8±69.8 min, P =0.544). Under total navigation (2020-2022), navigation barely affected the operation time in 1-disc-level MIS-TLIF (194.8±54.6 vs. 190.2±47.4 min, P =0.663) and even accelerated 2-disc-level surgery (279.9±64.1 vs. 362.7±80.7 min, P =0.002). There were no differences in blood loss and re-operation rate. The adaptation of navigation also facilitated long-segment (3- and 4-disc-level) cases, and the number gradually increased over the years, though not sufficient for analyses. Spinal navigation accelerated MIS-TLIF in multi (2 or more) disc-level cases after establishment and evolved toward a fluoro-less workflow. Navigation expanded MIS-TLIF to multilevel cases at similarly low complication rates. Level 3.