{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T04:50:20Z","timestamp":1777956620251,"version":"3.51.4"},"reference-count":40,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study introduces a modified minimally invasive transforaminal lumbar interbody fusion (MIS\u2010TLIF) technique to address the limitations of conventional MIS\u2010TLIF, including soft tissue injury, excessive reliance on intraoperative fluoroscopy, and a steep learning curve. We evaluated the clinical efficacy of this modified approach in the treatment of single\u2010level degenerative lumbar spine disease, with the aim of elucidating its advantages over the traditional technique and summarizing key technical considerations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study analyzed 286 patients who underwent surgery between January 2018 and July 2021 for single\u2010level degenerative lumbar disease. Patients were divided into modified MIS\u2010TLIF (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009131) and traditional MIS\u2010TLIF (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009155) groups. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) scores. Surgical parameters included operation time, intraoperative blood loss, fluoroscopy time, hospital stay, and complication rates. Radiographic assessments used CT and dynamic lateral X\u2010rays to evaluate interbody fusion, while MRI was used to measure the fatty infiltration ratio of the multifidus (MF\u2010FI Ratio). Continuous variables were compared between groups using independent\u2010samples\n                      <jats:italic>t<\/jats:italic>\n                      tests, whereas categorical variables were analyzed using the chi\u2010square test or Fisher's exact test when expected cell counts were &lt;\u20095. Paired t tests were employed to compare preoperative and postoperative measurements within each group. A two\u2010tailed\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05 was considered statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline characteristics showed no significant differences between groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Postoperative VAS, ODI, and JOA scores improved significantly in both groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). All cases achieved successful fusion at the final follow\u2010up. Compared to the traditional group, the modified MIS\u2010TLIF group had shorter operation time (101.83\u2009\u00b1\u200926.23 vs. 117.81\u2009\u00b1\u200927.87\u2009min), less blood loss (111.83\u2009\u00b1\u200926.22 vs. 147.68\u2009\u00b1\u200928.19\u2009mL), shorter fluoroscopy time (12.35\u2009\u00b1\u20091.72 vs. 50.33\u2009\u00b1\u20096.36\u2009s), fewer complications (5\/131 vs. 16\/155), and a lower MF\u2010FI ratio (36.67%\u2009\u00b1\u20094.52% vs. 39.61%\u2009\u00b1\u20094.58%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The modified MIS\u2010TLIF technique better preserves paravertebral muscles, reduces radiation exposure, shortens operative time, and lowers complication rates, offering a more optimized treatment option for managing single\u2010segment lumbar degeneration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.70290","type":"journal-article","created":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T05:45:11Z","timestamp":1774676711000},"page":"932-943","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Modified Freehand Minimally Invasive Transforaminal Lumbar Interbody Fusion for Single\u2010Level Degenerative Lumbar Disease: 3\u2010Year Multicenter Retrospective Outcomes"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7523-2328","authenticated-orcid":false,"given":"Yu","family":"Xiang","sequence":"first","affiliation":[{"name":"Department of Orthopedics Southwest Hospital, Army Medical University  Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics 958th Hospital of the PLA Army  Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0164-9472","authenticated-orcid":false,"given":"Jinyue","family":"He","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Southwest Hospital, Army Medical University  Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruonan","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Southwest Hospital, Army Medical University  Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Southwest Hospital, Army Medical University  Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4791-5411","authenticated-orcid":false,"given":"ZhongRong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics 958th Hospital of the PLA Army  Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5623-682X","authenticated-orcid":false,"given":"Tingting","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Southwest Hospital, Army Medical University  Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0662-4490","authenticated-orcid":false,"given":"Zehua","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Southwest Hospital, Army Medical University  Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200002150-00016"},{"key":"e_1_2_14_3_1","first-page":"2","article-title":"Lumbar Interbody Fusion: Techniques, Indications and Comparison of Interbody Fusion Options Including PLIF, TLIF, MI\u2010TLIF, OLIF\/ATP, LLIF and ALIF","volume":"1","author":"Mobbs R. J.","year":"2015","journal-title":"Journal of Spine Surgery"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.3171\/2009.7.FOCUS09121"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-195212000-00011"},{"key":"e_1_2_14_6_1","first-page":"1295","article-title":"Surgical Compared With Nonoperative Treatment for Lumbar Degenerative Spondylolisthesis. Four\u2010Year Results in the Spine Patient Outcomes Research Trial (SPORT) Randomized and Observational Cohorts","volume":"91","author":"Weinstein J. N.","year":"2009","journal-title":"Journal of Bone and Joint Surgery. American Volume"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1051624"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200212150-00004"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199304000-00009"},{"key":"e_1_2_14_10_1","first-page":"499","article-title":"Advances in Minimally Invasive Spine Surgery","volume":"49","author":"Foley K. T.","year":"2002","journal-title":"Clinical Neurosurgery"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-015-3903-4"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181c70fe3"},{"key":"e_1_2_14_13_1","first-page":"3868","article-title":"Minimally Invasive Lumbar Interbody Fusion via MAST Quadrant Retractor Versus Open Surgery: A Prospective Randomized Clinical Trial","volume":"124","author":"Wang H. L.","year":"2011","journal-title":"Chinese Medical Journal"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nec.2013.12.007"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-008-0687-8"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2010.09.004"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-197303000-00009"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/2192568219882346"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199802010-00014"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.13513"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2021.106165"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.13055"},{"key":"e_1_2_14_23_1","first-page":"13","article-title":"Anatomic Features of the Paramedian Muscle\u2010Splitting Approaches to the Lumbar Spine","volume":"66","author":"Hoh D. J.","year":"2010","journal-title":"Neurosurgery"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2013.07.459"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2019.05.055"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199612010-00011"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.3171\/spi.2007.6.2.121"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31817bb956"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-013-2853-y"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199604150-00007"},{"key":"e_1_2_14_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000202533.05906.ea"},{"key":"e_1_2_14_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-009-1191-6"},{"key":"e_1_2_14_33_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2018170072"},{"key":"e_1_2_14_34_1","volume-title":"Health Effects of Exposure to Low Levels of Ionizing Radiation: Beir V","author":"National Research Council (US) Committee on the Biological Effects of Ionizing R(V)","year":"1990"},{"key":"e_1_2_14_35_1","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.41.1.19"},{"key":"e_1_2_14_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e318252d44b"},{"key":"e_1_2_14_37_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta5120"},{"key":"e_1_2_14_38_1","doi-asserted-by":"publisher","DOI":"10.3171\/2014.10.SPINE14129"},{"key":"e_1_2_14_39_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/657342"},{"key":"e_1_2_14_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-015-3890-5"},{"key":"e_1_2_14_41_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12155125"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70290","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/os.70290","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70290","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T03:23:23Z","timestamp":1777951403000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.70290"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":40,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1111\/os.70290"],"URL":"https:\/\/doi.org\/10.1111\/os.70290","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]},"assertion":[{"value":"2025-09-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}