Abstract
Dear Editor
With great interest, we have studied and discussed a paper entitled “Long-Term Incidence of Adjacent Segmental Pathology After Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion” by Shin et al. 1 The study found that Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI - TLIF) and open TLIF in postoperative Radiographic ASP within 5 years (RASP) rate and Clinical ASP (CASP) in the first year after surgery were statistically different, but not at the 10-year follow-up. In the two groups in need to surgery adjacent segmental pathology (ASP) rate is no difference, but the open group has more preoperative adjacent intervertebral disc degeneration.We were interested in the long-term effects of minimally invasive (MI) vs open TLIF on adjacent segment pathology. Therefore, we have the following points to discuss with the authors.
Firstly, Yu et al. 2 found that endplate characteristics and implant design are related risk factors for the failure of LIF surgery. Therefore, the different endplate geometry in different patients or the mismatch with the design of the implant may lead to fusion failure, which in turn affects the reoperation rate. This study did not address the effect of patient endplate characteristics and implant design on reoperation rates. Comprehensive consideration of the factors leading to the occurrence of reoperation can make the study results more reliable.
Secondly, Lynch et al. 3 have shown that bilateral cage can effectively reduce the pressure on the spine due to its greater stability in MI-TLIF, while unilateral cage may increase the risk of postoperative ASP. In this study, the effect of the stability of unilateral cage and bilateral cage on postoperative ASP was not considered. If the authors further analyze the differences between unilateral cage and bilateral cage, the advantages of MI-TLIF can be further explored and the results can be more compelling.
Finally, MI-TLIF has important drawbacks that affect effects and long-term clinical outcomes due to insufficient visualization. 4 Bindal et al. 5 found that EMG monitoring as an adjunct to MI-TLIF can achieve safer pedicle cannulation. However, if you can use this study electrophysiological feedback auxiliary means such as improving the operation, not only can reduce the incidence of complications, also can improve the safety of surgery and minimally invasive placed on the accuracy of the instrument.
Once again, we appreciate the rigor and innovation the authors have shown in this study and look forward to their invaluable guidance on our questions.
