Letter to the Editor Regarding “Factors Associated with Reoperation after Minimally Invasive Tubular Transforaminal Lumbar Interbody Fusion: A Cohort Study of 756 Patients”

Abstract

We read with great interest the article by Lerch et al, who reported a 6.6% reoperation rate after tubular minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and identified osteoporosis/osteopenia, diabetes, WorkCover status, private funding, and previous lumbar surgery as associated factors. 1 This large cohort provides a valuable overview of revision indications and creates an opportunity to move from association toward mechanism-specific prevention. Cage migration and residual neural compromise accounted for half of the reoperations, whereas screw-related failure, subsidence, and repeated revision likely represent different pathways. Future studies could add standardized imaging variables, including disc morphology, three-dimensional cage position, cage-to-endplate coverage, cage height relative to preoperative disc height, endplate violation, segmental lordosis correction, screw trajectory, and decompression adequacy. 2 Blinded imaging adjudication could then classify revisions as technical, fixation-related, or disease-progression related, helping surgeons identify which part of the operative plan should be modified rather than merely labeling a patient as high risk. The association with osteoporosis/osteopenia