Adults can experience debilitating low back pain and functional impairment due to degenerative disc disease (DDD). Radiculopathy and mechanical back pain are symptoms of increasing disc dehydration, disc height loss, facet arthropathy, and segmental instability. Restoring disc height, decompressing neural elements, and stabilizing segments are all possible outcomes of surgical intervention like posterior lumbar interbody fusion (PLIF) when non-invasive treatments have not been effective [1-3]. Despite its widespread use and effectiveness for decades, traditional open PLIF is linked to lengthy recovery times, higher intraoperative blood loss, and substantial muscle dissection. In response to these restrictions, MI techniques have been developed to lessen the amount of soft-tissue disturbance that can occur during the procedure while yet producing the same clinical and radiological results as the open technique. MI-PLIF uses percutaneous instrumentation and tubular retractors to lessen muscle stress, which may lead to less postoperative pain, a shorter hospital stay, and a faster return to function [4-6]. In spite of these benefits in theory, whether MI-PLIF is clinically better than traditional open PLIF is still up for discussion. There are still worries about the minimally invasive approach's lengthier operating time, steeper learning curve, and possible difficulties in attaining sufficient decompression and fusion, even though multiple trials have shown positive perioperative outcomes with this method. To find out if MI-PLIF really gives the same or better results, comparative trials assessing functional outcomes, complication rates, and fusion success are necessary [7-9]. This study is to compare the radiological, clinical, and perioperative results of open and minimally invasive PLIF in patients suffering from degenerative disc disease, taking all of this into account. This study aims to provide evidence for optimal surgical decision-making for lumbar DDD therapy by analyzing both short-term healing characteristics and long-term fusion success.

A prospective comparative study was conducted on 60 patients diagnosed with degenerative disc disease (DDD) and scheduled for single-level posterior lumbar interbody fusion (PLIF). The study was carried out at a tertiary care spine centre at the Department of Neurosurgery, Government Medical College Sangareddy, Telangana between March 2024 to February 2025. Institutional Ethics Committee approval was obtained before commencing the study, and written informed consent was secured from all participants. Inclusion Criteria: • Patients aged 18–70 years • Diagnosed with single-level degenerative disc disease. • Failed minimum 6 weeks of conservative management • Indication for lumbar fusion due to persistent pain or neurological symptoms • Ability to provide informed consent Exclusion Criteria: • Multi-level lumbar degenerative disease • Previous lumbar spine surgery • Spondylolisthesis grade > I • Spinal infections, tumors, or trauma • Severe osteoporosis (T-score ≤ –2.5) • Severe medical comorbidities unsuitable for surgery • Pregnancy • Incomplete data or failure to follow up Statistical Analysis: We used SPSS software to analyze the data. The Student's t-test was used to compare continuous variables (VAS, ODI, blood loss, operative time) which were presented as mean ± standard deviation. We used Fisher's exact test or Chi-square test to compare the categorical variables (complication rates, fusion success). Statistical significance was determined by a p-value less than 0.05. Using paired t-tests, we compared the pre- and post-operative scores (VAS, ODI) of each group. Appropriate line diagrams and bar charts were used for the graphical representation.

A total of 60 patients were enrolled and divided equally into two groups: Minimally Invasive PLIF (MI-PLIF, n = 30) and Open PLIF (O-PLIF, n = 30). The findings are presented below. Table 1. Demographic and Baseline Characteristics of Patients Parameter MI-PLIF (n = 30) O-PLIF (n = 30) p-value Age (years, mean ± SD) 52.3 ± 8.4 53.7 ± 9.1 0.54 Gender (M/F) 17/13 18/12 0.79 BMI (kg/m²) 26.1 ± 3.2 25.8 ± 2.9 0.66 Pre-op VAS score 7.8 ± 1.1 7.6 ± 1.2 0.42 Pre-op ODI (%) 62.5 ± 8.3 61.7 ± 7.9 0.68 The demographic and clinical variables at baseline are compared in Table 1. Age, gender distribution, body mass index, preoperative pain, and disability scores were all similarly distributed among the two groups. Table 2. Intraoperative Parameters Parameter MI-PLIF (n = 30) O-PLIF (n = 30) p-value Operative time (min) 142 ± 25 136 ± 28 0.28 Estimated blood loss (mL) 165 ± 40 325 ± 65 <0.001* Incision length (cm) 3.8 ± 0.7 11.2 ± 1.9 <0.001* Dural tear (%) 1 (3.3%) 2 (6.6%) 0.55 *Statistically significant Table 2 reveals that MI-PLIF resulted in much lower blood loss and smaller incision size than open PLIF. Operative time was marginally longer in the least invasive group but not statistically significant. Table 3. Early Postoperative Outcomes Parameter MI-PLIF (n = 30) O-PLIF (n = 30) p-value VAS at 24 hours 3.1 ± 0.8 5.2 ± 1.1 <0.001* VAS at 48 hours 2.7 ± 0.7 4.4 ± 1.0 <0.001* Time to ambulation (hours) 22.4 ± 4.6 34.7 ± 6.2 <0.001* Hospital stay (days) 3.4 ± 0.9 5.8 ± 1.4 <0.001* *Statistically significant Results such as reduced pain levels, quicker ambulation, and shorter hospital stays were significantly superior in the MI-PLIF group in the early postoperative period (Table 3). Table 4. Postoperative Complications Complication MI-PLIF (n = 30) O-PLIF (n = 30) p-value Superficial infection 1 (3.3%) 3 (10%) 0.30 Hematoma 0 1 (3.3%) 0.31 Neurological deficit 1 (3.3%) 2 (6.6%) 0.55 Implant-related issues 0 1 (3.3%) 0.31 Total complication rate 2 (6.6%) 7 (23.3%) 0.04* *Statistically significant Table 4 shows that the MI-PLIF group had fewer problems. The open PLIF group had a substantially greater total complication rate. Table 5. Radiological Fusion Rates at 12 Months Outcome MI-PLIF (n = 30) O-PLIF (n = 30) p-value Fusion achieved 27 (90%) 26 (87%) 0.72 Non-fusion / delayed fusion 3 (10%) 4 (13%) — The fusion rates at 12 months were similar in both groups (Table 5), and there was no statistically significant difference between them. The fusion success rates were high for both methods.

In this study compared the radiological, clinical, and perioperative results of open PLIF (O-PLIF) with minimally invasive PLIF (MI-PLIF) for patients suffering from degenerative disc disease. The results show that compared to the open method, the minimally invasive method achieves long-term fusion rates that are comparable and offers numerous significant benefits in the early postoperative period [10-12]. Important findings from this study included decreased incision sizes and substantially less intraoperative blood loss linked to MI-PLIF. These results are in line with what has been reported in the past about the fact that minimally invasive spinal treatments reduce blood loss and tissue damage by minimizing muscle trauma and soft-tissue stripping. The minimally invasive group did have a somewhat longer operating time, but this difference was not statistically significant. It is possible that this is due to the technical learning curve that is associated with MI-PLIF [13-15]. In previous study individuals who underwent MI-PLIF had significantly reduced pain scores at the 24-and 48-hour postoperative mark. Less nociceptive stimulation and quicker healing were probably caused by less muscle disturbance and smaller incisions. The fact that MI-PLIF patients needed fewer inpatient days and could ambulate earlier is consistent with this. These results support the recent emphasis in research on lumbar fusion procedures on the short-term recovery advantages of less invasive procedures [16-18]. Results showed that MI-PLIF was preferable to the open approach in terms of complication rates, with a markedly decreased frequency of postoperative problems. The risk of infection and wound-related morbidity is predicted to be lower with MI-PLIF due to the reduced soft-tissue injury and lesser exposure. While both groups did experience neurological difficulties, the occurrence of these issues was minimal and in line with what is reported internationally [19-21]. In previous studies it is worth noting that fusion rates at 12 months were comparable across MI-PLIF and O-PLIF (90% vs. 87%), even though minimally invasive surgery inherently reduces exposure. This discovery proves that less invasive methods can achieve stable fusion results that are on par with conventional open methods. Thanks to advancements in minimally invasive surgical systems, such as better equipment, cage design, and surgical precision, comparable fusion success has been attained [22-24]. As a whole, the study's findings support the idea that MI-PLIF improves early postoperative recovery significantly without sacrificing structural outcomes in the long run. Minimally invasive techniques seem to offer additional benefits, such as less postoperative discomfort, faster mobilization, shorter hospital stay, and fewer problems, yet open PLIF is still a dependable treatment. For the right patients, MI-PLIF is a great option because of these advantages. Outcomes may differ according on surgeon experience, and it is important to note that MI-PLIF necessitates sophisticated surgical skills and specific equipment. Further validation of these findings and assessment of their applicability across varied patient populations require larger multicentric studies with longer follow-up [25-27].

Patients suffering from degenerative disc disease have a better chance of a successful operation when they undergo minimally invasive posterior lumbar interbody fusion (MI-PLIF) instead of the more conventional open PLIF method. Fewer problems, quicker ambulation, shorter hospital stays, less intraoperative blood loss, and less postoperative discomfort were all outcomes of MI-PLIF. As both methods showed similar fusion rates at 12 months, it is important to note that these short-term advantages were accomplished without sacrificing long-term results. When it comes to carefully chosen patients, MI-PLIF is a better, less invasive, and more therapeutically beneficial option than open PLIF. We should expect these results to improve much more as surgeons hone their skills and minimally invasive procedures advance. Funding None Conflict of Interest: None

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