Lordosis Restoration With Midline Minimally Invasive Cortical Trajectory Screws (MidLF) and Transforaminal Interbody Fusion: A Safe Technique With a Short Stay

Background: The minimally invasive cortical trajectory screw (MidLF) technique has been described accompanied with posterolateral interbody fusion (PLIF). We present our 2-year results of a hybrid technique to show that using transforaminal interbody fusion (TLIF) rather than PLIF in conjunction with MidLF is a less invasive and safe technique. Methods: We retrospectively identified 25 patients who underwent MidLF with TLIF from July 2015 through September 2017. The surgical technique was the same for each, with radiological, clinical, and patient-reported outcome data collected and analyzed at a 2-year follow-up. Results: The cohort showed a mean age of 55 (35-85) years. The length of hospital stay was between 1 and 4 days, with an average of 2.7 days. Postoperatively, lordosis across the motion segment fused increased by a mean of 7.3 degrees (0 degrees-24 degrees), mean pelvic incidence was 53 degrees(31 degrees-80 degrees), and pelvic tilt reduced by an average of 3.5 degrees (0 degrees-11 degrees). The Oswestry Disability Index improved from 34 preoperatively to 19 postoperatively. Visual analogue pain score-leg improved by 4.7 points, from 6 down to 1. One patient showed delayed wound healing. There were no incidences of neurological injury or durotomy. Conclusions: Our data suggests that MidLF with TLIF is both less invasive than traditional techniques and safe. It restores lordosis, requires less exposure and retraction of neural elements than the more widely used PLIF, and shows early discharge and satisfactory medium-term patient-reported outcomes.