Application of the multifidus muscle approach in minimally invasive transforaminal lumbar interbody fusion

YANG Xiu-lun; LI Cong-can; ZHOU Rui; XIAO Jun; HE Lei; LIU Yao-yao; SONG Lei; DAI Fei

doi:10.11659/jjssx.03E026016

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Application of the multifidus muscle approach in minimally invasive transforaminal lumbar interbody fusion

Clinical Research | 更新时间：2026-10-26

- Application of the multifidus muscle approach in minimally invasive transforaminal lumbar interbody fusion
- JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY Vol. 35, Issue 10, Pages: 885-889(2026)
- 作者机构：
  
  1.陆军军医大学第一附属医院骨科，重庆 400038
  2.中国人民解放军75560部队，海南屯昌 571600
  3.火箭军广州特勤疗养中心特勤胜利训练科，广东广州 515515
  4.中国人民解放军31637部队，云南玉溪 653100
  5.中国人民解放军陆军特色医学中心脊柱外科，重庆 400042
- 作者简介：
- 基金信息：
- DOI：10.11659/jjssx.03E026016
  CLC： R687
- Received：04 March 2026，
  
  Revised：2026-09-20，
  
  Accepted：21 May 2026，
  
  Published：25 October 2026
- 稿件说明：
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杨秀伦,李丛灿,周锐等.多裂肌入路在微创经椎间孔腰椎椎体间融合术中的应用[J].局解手术学杂志,2026,35(10):885-889.

YANG Xiu-lun,LI Cong-can,ZHOU Rui,et al.Application of the multifidus muscle approach in minimally invasive transforaminal lumbar interbody fusion[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(10):885-889.
杨秀伦,李丛灿,周锐等.多裂肌入路在微创经椎间孔腰椎椎体间融合术中的应用[J].局解手术学杂志,2026,35(10):885-889. DOI： 10.11659/jjssx.03E026016.

YANG Xiu-lun,LI Cong-can,ZHOU Rui,et al.Application of the multifidus muscle approach in minimally invasive transforaminal lumbar interbody fusion[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(10):885-889. DOI： 10.11659/jjssx.03E026016.

摘要

目的

探讨多裂肌入路在微创经椎间孔腰椎椎体间融合术（MIS-TLIF）中的应用价值。

方法

回顾性分析2017年6月至2024年3月于陆军军医大学第一附属医院接受单/双节段MIS-TLIF治疗的692例腰椎退行性疾病患者的临床资料，按手术入路分为多裂肌入路组（476例）、Wiltse入路组（216例）。比较2组患者围术期指标、Cage置入参数、视觉模拟量表（VAS）评分及Oswestry功能障碍指数（ODI）、融合率及并发症发生率；采用多因素Logistic回归分析术后并发症发生的危险因素。

结果

2组患者出血量、住院时间、Cage置入参数、VAS评分、ODI、牢固融合率及术后并发症总发生率比较，差异均无统计学意义（

0.05）。多裂肌入路组患者手术时间显著短于Wiltse入路组（

0.05）。多因素Logistic回归分析结果显示，双节段手术、骨质疏松、合并2型糖尿病是术后并发症发生的独立危险因素。

结论

多裂肌入路MIS-TLIF治疗腰椎退行性疾病可获得与Wiltse入路相近的临床疗效、融合效果及安全性，并可缩短手术时间；双节段手术、骨质疏松及合并2型糖尿病与术后并发症发生风险增加相关，术前应予以重视。

Abstract

Objective

To explore the application value of the multifidus muscle approach in minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF）.

Methods

The clinical data of 692 patients with lumbar degenerative disease who underwent single‑ or double‑level MIS‑TLIF at the First Affiliated Hospital of Army Medical University from June 2017 to March 2024 were retrospectively analyzed. The patients were divided into the multifidus muscle approach group （

=476） and the Wiltse approach group （

=216）.The perioperative parameters，Cage placement parameters，visual analogue scale （VAS） scores， Oswestry disability index （ODI）， fusion rate， and complication rate of patients in the two groups were compared.Multivariate Logistic regression analysis was performed to identify risk factors for postoperative complications.

Results

No statistically significant differences were observed between the two groups in blood loss， hospital stay，Cage placement parameters，VAS scores，ODI，solid fusion rate，or overall postoperative complication rate（

0.05）. The operative time of patients in the multifidus muscle approach group was significantly shorter than that in the Wiltse approach group（

0.05）.Multivariate Logistic regression analysis showed that double-level surgery，osteoporosis，and type 2 diabetes were the independent risk factors for postoperative complications.

Conclusion

MIS‑TLIF via the multifidus muscle approach for lumbar degenerative diseases achieves clinical efficacy，fusion outcomes，and safety comparable to the Wiltse approach，while shortening operative time.Double-level surgery，osteoporosis，and type 2 diabetes are associated with an increased risk of postoperative complications， which should be emphasized preoperatively.

关键词

Keywords

references

Hartvigsen J ， Hancock MJ ， Kongsted A ， et al . What low back pain is and why we need to pay attention ［J］. Lancet ， 2018 ， 391 （ 10137 ）： 2356 - 2367 . doi： 10.1016/s0140-6736（18）30480-x http://dx.doi.org/10.1016/s0140-6736（18）30480-x .

Katz JN ， Zimmerman ZE ， Mass H ， et al . Diagnosis and management of lumbar spinal stenosis：a review ［J］. Jama ， 2022 ， 327 （ 17 ）： 1688 - 1699 . doi： 10.1001/jama.2022.5921 http://dx.doi.org/10.1001/jama.2022.5921 .

Phani Kiran S ， Sudhir G . Minimally invasive transforaminal lumbar interbody fusion - a narrative review on the present status ［J］. J Clin Orthop Trauma ， 2021 ， 22 ： 101592 . doi： 10.1016/j.jcot.2021.101592 http://dx.doi.org/10.1016/j.jcot.2021.101592 .

Dada A ， Saggi S ， Ambati VS ， et al . Evolution of the minimally invasive surgery transforaminal lumbar interbody fusion：where are we now？［J］. Neurosurgery ， 2025 ， 96 （ 3S ）： S33 - S41 . doi： 10.1227/neu.00000000 00003336 http://dx.doi.org/10.1227/neu.0000000000003336 .

Wu X ， Liu W ， Xiao X ， et al . Comparison of the clinical outcomes of VBE-TLIF versus MIS-TLIF for single-level degenerative lumbar diseases ［J］. Eur Spine J ， 2024 ， 33 （ 3 ）： 1120 - 1128 . doi： 10.1007/s00586-023-08096-3 http://dx.doi.org/10.1007/s00586-023-08096-3 .

Palmer DK ， Allen JL ， Williams PA ， et al . Multilevel magnetic resonance imaging analysis of multifidus-longissimus cleavage planes in the lumbar spine and potential clinical applications to Wiltse's paraspinal approach ［J］. Spine （Phila Pa 1976）， 2011 ， 36 （ 16 ）： 1263 - 1267 . doi： 10.1097/BRS.0b013e3181f520e8 http://dx.doi.org/10.1097/BRS.0b013e3181f520e8 .

Shen X ， Li FT ， Cheng YQ ， et al . Comparison of a novel hand-held retractor-assisted transforaminal lumbar interbody fusion by the wiltse approach and posterior TLIF：a one-year prospective controlled study ［J］. BMC Musculoskelet Disord ， 2024 ， 25 （ 1 ）： 142 . doi： 10.1186/s12891-024-07248-w http://dx.doi.org/10.1186/s12891-024-07248-w .

Buckland AJ ， Proctor DJ . Minimally invasive transforaminal lumbar interbody fusion with expandable cages ［J］. JBJS Essent Surg Tech ， 2023 ， 13 （ 2 ）： e21.00062 . doi： 10.2106/jbjs.St.21.00062 http://dx.doi.org/10.2106/jbjs.St.21.00062 .

Hu W ， Yang G ， Wang H ， et al . Which is better in clinical and radiological outcomes for lumbar degenerative disease of two segments：MIS-TLIF or OPEN-TLIF？［J］. J Pers Med ， 2022 ， 12 （ 12 ）： 1977 . doi： 10.3390/jpm12121977 http://dx.doi.org/10.3390/jpm12121977 .

Pakzaban P . Modified mini-open transforaminal lumbar interbody fusion：description of surgical technique and assessment of free-hand pedicle screw insertion ［J］. Spine （Phila Pa 1976）， 2016 ， 41 （ 18 ）： E1124 - E1130 . doi： 10.1097/brs.0000000000001510 http://dx.doi.org/10.1097/brs.0000000000001510 .

Zhang W ， Li X ， Shang X ， et al . Modified minimally invasive transforaminal lumbar interbody fusion using a trans-multifidus approach：a safe and effective alternative to open-TLIF ［J］. J Orthop Surg Res ， 2015 ， 10 ： 93 . doi： 10.1186/s13018-015-0234-4 http://dx.doi.org/10.1186/s13018-015-0234-4 .

Bridwell KH ， Lenke LG ， Mcenery KW ， et al . Anterior fresh frozen structural allografts in the thoracic and lumbar spine.Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects？［J］. Spine （Phila Pa 1976）， 1995 ， 20 （ 12 ）： 1410 - 1418 .

Liu H ， Li J ， Sun Y ， et al . A comparative study of a new retractor-assisted WILTSE TLIF，MIS-TLIF，and traditional pLIF for treatment of single-level lumbar degenerative diseases ［J］. Orthop Surg ， 2022 ， 14 （ 7 ）： 1317 - 1330 . doi： 10.1111/os.13289 http://dx.doi.org/10.1111/os.13289 .

Shahi P ， Subramanian T ， Tuma O ， et al . Temporal trends of improvement after minimally invasive transforaminal lumbar interbody fusion ［J］. Spine （Phila Pa 1976）， 2025 ， 50 （ 2 ）： 81 - 87 . doi： 10.1097/brs.0000 000000005024 http://dx.doi.org/10.1097/brs.0000000000005024 .

Huang J ， Rabin EE ， Stricsek GP ， et al . Outcomes and complications of minimally invasive transforaminal lumbar interbody fusion in the elderly：a systematic review and meta-analysis ［J］. J Neurosurg Spine ， 2022 ， 36 （ 5 ）： 741 - 752 . doi： 10.3171/2021.7.Spine21829 http://dx.doi.org/10.3171/2021.7.Spine21829 .

Basques BA ， Anandasivam NS ， Webb ML ， et al . Risk factors for blood transfusion with primary posterior lumbar fusion ［J］. Spine （Phila Pa 1976）， 2015 ， 40 （ 22 ）： 1792 - 1797 . doi： 10.1097/brs.000000000000 1047 http://dx.doi.org/10.1097/brs.0000000000001047 .

Kim BD ， Hsu WK ， Jr De Oliveira GS ， et al . Operative duration as an independent risk factor for postoperative complications in single-level lumbar fusion：an analysis of 4588 surgical cases ［J］. Spine （Phila Pa 1976）， 2014 ， 39 （ 6 ）： 510 - 520 . doi： 10.1097/brs.000000000000 0163 http://dx.doi.org/10.1097/brs.0000000000000163 .

Fan SW ， Hu ZJ ， Fang XQ ， et al . Comparison of paraspinal muscle injury in one-level lumbar posterior inter-body fusion：modified minimally invasive and traditional open approaches ［J］. Orthop Surg ， 2010 ， 2 （ 3 ）： 194 - 200 . doi： 10.1111/j.1757-7861.2010.00086.x http://dx.doi.org/10.1111/j.1757-7861.2010.00086.x .

Bovonratwet P ， Samuel AM ， Mok JK ， et al . Minimally invasive lumbar decompression versus minimally invasive transforaminal lumbar interbody fusion for treatment of low-grade lumbar degenerative spondylolisthesis ［J］. Spine （Phila Pa 1976）， 2022 ， 47 （ 21 ）： 1505 - 1514 . doi： 10.1097/brs.0000000000004432 http://dx.doi.org/10.1097/brs.0000000000004432 .

Heemskerk JL ， Oluwadara Akinduro O ， Clifton W ， et al . Long-term clinical outcome of minimally invasive versus open single-level transforaminal lumbar interbody fusion for degenerative lumbar diseases：a meta-analysis ［J］. Spine J ， 2021 ， 21 （ 12 ）： 2049 - 2065 . doi： 10.1016/j.spinee.2021.07.006 http://dx.doi.org/10.1016/j.spinee.2021.07.006 .

Narain AS ， Parrish JM ， Jenkins NW ， et al . Risk factors for medical and surgical complications after single-level minimally invasive transforaminal lumbar interbody fusion ［J］. Int J Spine Surg ， 2020 ， 14 （ 2 ）： 125 - 132 . doi： 10.14444/7018 http://dx.doi.org/10.14444/7018 .

Buyuk AF ， Shafa E ， Dawson JM ， et al . Complications with minimally invasive transforaminal lumbar interbody fusion for degenerative spondylolisthesis in the obese population ［J］. Spine （Phila Pa 1976）， 2019 ， 44 （ 23 ）： E1401 - E1408 . doi： 10.1097/brs.000000000000 3160 http://dx.doi.org/10.1097/brs.0000000000003160 .

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