***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Study Design . Prospect i ve longitudinal clinical study . Objective . The purpose of our article was to investigate the clinical outcomes with type and level of disc herniation in a young , active population undergoing lumbar microdiscectomy .  Summary of Background Data . There are few reported outcomes studies on the relationship between disc herniation level , type of disc herniation , and surgical outcomes of lumbar microdiscectomy in a young , active population . Methods . One hundred ninety-seven ( 197 ) consecutive single-level lumbar microdiscectomies performed by a single surgeon were prospect ively followed over a 3-year period . All patients had failed a period of nonoperative care including physical therapy and /or transforaminal epidural steroid injections . One hundred eighty-three patients ( 139 males , 44 females ) with a mean age of 27.0 years ( range 19–46 years ) were prospect ively followed for a mean of 26 months ( range , 12–38 months ) . Outcomes were assessed using Visual Analog Scale ( VAS ) , Oswestry disability index , patient satisfaction , return to military duty , and need for additional surgery . The type of disc herniation ( contained , extruded , or sequestered ) and the lumbar level of herniation were also recorded . Results . At final follow-up , 84 % ( 154 of 183 ) of patients had returned to unrestricted military duty ; 16 % ( 29 ) had been medically discharged . The mean decrease in VAS leg pain score was 4.7 points ( from mean preoperative 7.2 to mean postoperative 2.5 ) ; 80 % ( 146 ) reported a decrease of greater than 2 points . The mean Oswestry index improved from 53.6 before surgery to 21.2 at final follow-up . Overall , 85 % ( 156 ) were satisfied with their surgery . Six patients had recurrent herniations ( 3 % ) with 4 of the 6 undergoing additional surgery . Patients with preoperative VAS scores consistent with a preponderance of radicular leg pain versus back pain demonstrated better surgical outcomes in all categories ( P < 0.001 ) When classified by disc herniation type , sequestered discs at all levels demonstrated better Oswestry and VAS scores versus extruded or contained disc herniations . ( P < 0.001 ) Disc herniations at the L5–S1 level had significantly greater improvements in both mean VAS leg and Oswestry outcome scores than disc herniations at the L4–L5 level . ( P < 0.001 ) Preexisting restricted duty status at time of first surgical consultation was associated with poorer outcomes . Smokers had a significantly lower return to full active military duty ( P = 0.037 ) . Conclusion . Microdiscectomy for symptomatic lumbar disc herniations in young , active patients with a preponderance of leg pain who have failed nonoperative treatment demonstrated a high success rate based on vali date d outcome measures , patient satisfaction , and return to active duty . Patients with disc herniations at the L5–S1 level had significantly better outcomes than did those at the L4–L5 level . Patients with sequestered or extruded lumbar disc herniations had significantly better outcomes than did those contained herniations . Patients with contained disc herniations , a predominance of back pain , on restricted duty and smoking should be counseled before surgery of the potential for less satisfaction , poorer outcomes scores , and decreased return to duty rates Objective The purpose of this study was to assess the clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody fusion ( MI-TLIF ) surgery for degenerative lumbar spine disease . Methods A prospect i ve analysis of 34 consecutive patients who underwent a MI-TLIF using image guidance between July 2008 and November 2010 . The patient group comprised 19 males and 15 females ( mean age 56 ) , 23 of whom had undergone additional reduction of spondylolisthesis . All patients underwent post-operative CT imaging to assess pedicle screw , cage placement and fusion at 6 months . Oswestry Disability Index ( ODI ) scores were recorded pre-operatively and at 6-month follow up . Results 33/34 ( 97.1 % ) patients showed evidence of fusion at 6 months with a mean improvement of 27 on ODI scores . The mean length of hospital stay was 4 days . The mean operative time was 173 min . Complications observed1/34 ( 2.9 % ) suffered a pulmonary embolism and 1/34 ( 2.9 % ) patients developed transient nerve root pain post-operatively . There were no occurrences of infection and no post-operative CSF leaks . Conclusion MI-TLIF offers patients a safe and effective surgical treatment option to treat degenerative lumbar spine disease Study Design : This is a prospect i ve single-center nonr and omized control clinical study involving 81 overweight or obese patients who underwent minimally invasive or open transforaminal lumbar interbody fusion ( TLIF ) .  Objective : The objective of this study was to evaluate the safety and efficacy of minimally invasive TLIF  as an alternative technique in overweight or obese patients . Summary of Background Data : Spinal surgery in obese patients is associated with increased complications , blood loss , and operative times . The potential benefits of minimally invasive lumbar surgery in obese patients have been discussed in a few studies . However , there have been no prospect i ve clinical reports published on the comparison of minimally invasive or open TLIF ( OTLIF ) in obese patients . Methods : Eighty-one patients , 25 male and 56 female , with an average age of 55.3 years ( 43–81 y ) were prospect ively evaluated . The main inclusion criterion was a body mass index ≥25 . The mean body mass index was 28.9±3.2 . All patients suffering from lumbar canal stenosis ( n=43 ) , spondylolisthesis ( n=29 ) , or postlaminectomy instability ( n=9 ) underwent  1-level minimally invasive TLIF ( MiTLIF , n=43 ) or OTLIF ( n=39 ) . The following data were compared between 2 groups : operative time , blood loss , x-ray exposure time , clinical and radiographic outcomes , and perioperative complications . The clinical outcome was assessed using the visual analogue scale and the Oswestry Disability Index ( ODI ) . Radiographic evaluation of the lumbar spine was performed at 12 months postoperatively . Results : In comparison with the OTLIF group , the MiTLIF group had significantly less operating time , less blood loss , and less postoperative back pain . The radiation time was significantly longer in the MiTLIF group . The clinical outcomes ( Oswestry Disability Index scores ) were basically identical in the 2 groups . Radiographic evaluation showed satisfactory bony union at the fixed level in both the MiTLIF group ( 42/43 cases ) and the OTLIF group ( 38/39 cases ) . Overall complication rates were slightly higher in the OTLIF group , with 17.9 % of overweight or obese patients having perioperative complications . Conclusions : MiTLIF is a safe and reliable procedure for treatment of overweight or obese patients . The minimally invasive technique offers several potential advantages when compared with the open procedure . Although this technique needs a longer x-ray exposure time , it may still be a good option for overweight or obese patients Abstract Transforaminal percutaneous endoscopic lumbar discectomy ( PELD ) is gradually regarded as an effective alternative to posterior open surgery . However , migrated herniations bring a great technical challenge even for experienced surgeons due to the absence of the appropriate approaching guideline . We aim ed to describe a safe and effective approaching technique for the removal of down-migrations on the basis of the clinical outcomes and complications compared with the conventional approaching method .A total of 45 patients recommended to single-level PELD with foraminoplasty were r and omly divided into 2 groups , group A received foraminoplasty via upper border of inferior pedicle , group B was approached through the common transforaminal route . The clinical outcomes were evaluated by Visual Analog Scale ( VAS ) for leg pain and Oswestry Disability Index ( ODI ) scores . Then participants were classified into 2 types of migrations ( high- grade and low- grade ) based on the extent of migration presented on preoperative magnetic resonance imaging ( MRI ) . The various comparisons between the 2 surgical techniques were analyzed . The postoperative VAS and ODI scores significantly decreased in both of the 2 groups after surgery ( P < 0.001 ) . The follow-up continued 1 year . With increasing length of follow-up , the disparities in clinical outcomes between the 2 groups were gradually narrowing and there was no significant difference at the end of follow-up ( P = 0.32 ; P = 0.46 ) . There were no differences in the operation time and duration of hospital stay ( P = 0.36 ; P = 0.08 ) . The highly migration group in group B showed a significant longer operation time ( P = 0.02 ) , but the extent of migration did not have a significant influence on the operation time in group A with the modified approach ( P = 0.19 ) . There were no apparent approach-related complications in group A during the procedure and follow-up period . Foraminoplastic-PELD via upper border of inferior pedicle can serve as a safe and effective minimally invasive technique for removal of down-migrated herniations . Furthermore , it is essential to identify the radiologic characteristics so as to choose the most appropriate approaching technique Study Design . This was a prospect i ve clinical study that took place in an outpatient spine clinic . Objective . To demonstrate the short-/long-term outcomes from a large cohort of patients undergoing minimally invasive transforaminal lumbar interbody fusion ( MITLIF ) .  Summary of Background Data . Long-term prospect i ve outcomes in patients undergoing minimally invasive spinal fusion for debilitating back pain has not been well studied . Methods . Presenting diagnosis was determined from clinical findings and radiographical ( radiograph , magnetic resonance image , computed tomographic scan ) evaluations preoperatively . Patients were assessed with outcome measures preoperatively , and postoperatively at 2 weeks , 3 months , 6 months , 12 months , 24 months , and annually 2 to 7 years ( mean follow-up : 47 mo ) final follow-up . The rate of postoperative complications and reoperations at the initial level of MITLIF and adjacent level(s ) were followed . Fusion rates were assessed blinded and independently by radiograph . Results . Visual analogue scale scores decreased significantly from 7.0 preoperatively to 3.5 at mean 47-month follow-up . Oswestry Disability Index scores declined from 43.1 preoperatively to 28.2 at mean 47-month follow-up . Short-Form 36 mental component scores increased from 43.8 preoperatively to 49.7 at 47-month follow-up . Short-Form 36 physical component scores increased from 30.6 preoperatively to 39.6 at 47-month follow-up ( P < 0.05 ) . Conclusion . This prospect ively collected outcomes study shows long-term statistically significant clinical outcomes improvement after MITLIF in patients with clinical ly symptomatic spondylolisthesis and degenerative disc disease with or without stenosis .  MITLIF result ed in a high rate of spinal fusion and very low rate of interbody fusion failure and /or adjacent segment disease requiring reoperation while reducing postoperative complications . Level of Evidence : Abstract The aim of the study was to compare the radiographic and clinical outcomes between posterior short-segment pedicle instrumentation combined with lateral-approach interbody fusion and traditional anterior-posterior ( AP ) surgery for the treatment of thoracolumbar fractures . Lateral-approach interbody fusion has achieved satisfactory results for thoracic and lumbar degenerative disease . However , few studies have focused on the use of this technique for the treatment of thoracolumbar fractures . Inclusion and exclusion criteria were established . All patients who meet the above criteria were prospect ively treated by posterior short-segment instrumentation and secondary -staged minimally invasive lateral-approach interbody fusion , and classified as group A. A historical group of patients who were treated by traditional wide-open AP approach  was used as a control group and classified as group B. The radiological and clinical outcomes were compared between the 2 groups . There were 12 patients in group A and 18 patients in group B.  The mean operative time and intraoperative blood loss of anterior reconstruction were significantly higher in group B than those in group A ( 127.1 ± 21.7 vs 197.5 ± 47.7 min , P < 0.01 ; 185.8 ± 62.3 vs 495 ± 347.4 mL , P < 0.01 ) . Two of the 12 ( 16.7 % ) patients in group A experienced 2 surgical complications : 1 ( 8.3 % ) major and 1 ( 8.3 % ) minor . Six of the 18 ( 33 % ) patients in group B experienced 9 surgical complications : 3 ( 16.7 % ) major and 6 ( 33.3 % ) minor . There was no significant difference between the 2 groups regarding loss of correction ( 4.3 ± 2.1 vs 4.2 ± 2.4 , P = 0.89 ) and neurological function at final follow-up ( P = 0.77 ) . In both groups , no case of instrumentation failure , pseudarthrosis , or nonunion was noted . Compared with the wide-open AP surgery , posterior short-segment pedicle instrumentation , combined with minimally invasive lateral-approach interbody fusion , can achieve similar clinical results with significant less operative time , blood loss , and surgical complication . This procedure seems to be a reasonable treatment option for selective patients with thoracolumbar fractures Objective To test the equivalence for clinical effectiveness between microdecompression and lamine 
    Output:
    
MISS-laminectomy/discectomy , TLIF , and PLIF appear to be similar in terms of postoperative pain and perioperative blood loss .
MISS TLIF is perhaps more effective in specific outcome measures and results in less intraoperative blood loss than open TLIF