MIS-TLIF Combined with Contralateral Bridge Fixation of Minimally Invasive Pedicle Screws for Multilevel Lumbar Degenerative Disease

Presented at SMISS Annual Forum 2016
By Yutong Gu MD, PhD
With Jian Dong , Xiaoxing Jiang , Jian Zhang ,

Disclosures: Yutong Gu MD, PhD None Jian Dong None, Xiaoxing Jiang None, Jian Zhang None,


Unilateral MIS-TLIF (minimally invasive transforaminal lumbar interbody fusion) has widely used to treat single level lumbar degenerative disease. However, for multilevel lumbar degenerative diseases there is no optimal minimally invasive strategy. 


The purpose of study is to evaluate the feasibility, efficacy and safety of MIS-TLIF combined with contralateral bridge fixation of MIPS (minimally invasive pedicle screws) for the treatment of multilevel lumbar degenerative diseases.


MIS-TLIF combined with contralateral bridge fixation of MIPS (only insertion of pedicle screws into the two end vertebrae through the minimal-access in a paraspinal sacrospinalis muscle-splitting approach under direct vision and placement of rod over the pedicle screws through subcutaneous soft tissues and muscles) was performed to treat 45 cases of lumber degenerative diseases (canal stenosis, disc herniation with instability or spondylolisthesis) including 28 cases of 2-level, 15 cases of 3-level and 2 cases of 4-level. The average follow-up duration was 28.6 (24~32) months. Back and leg pain were preoperatively and postoperatively evaluated using VAS. And the clinical outcomes were evaluated with Oswestry Disability Index (ODI) at the final follow-up. The radiological outcomes were evaluated according to the change of bone bridging, the radiolucency, the instability and the disc height. 


For the clinical evaluation, the VAS pain index and the ODI showed excellent outcomes. For the radiological evaluation, 45 cases showed complete bone union at the final follow-up. 


Contralateral bridge fixation of MIPS has some advantages of fast implantation of pedicle screws, easy installation of rod into screws and less X-ray exposure compared with percutaneous pedicle screws. MIS-TLIF combined with contralateral bridge fixation of MIPS is a good choice of minimally invasive surgery for multilevel lumbar degenerative diseases.