MINIMALLY INVASIVE TLIF

What is Minimally Invasive TLIF?

Minimally Invasive Transforaminal Interbody Fusion refers to a variation of a similar surgery; posterior lumbar interbody fusion, often performed as a surgical procedure that requires minimal incision (as the name implies- minimally invasive). For the sake of brevity, spinal specialists usually refer to this surgery in its shorter term; “MIS TLIF”. This surgical procedure aims to relieve back ache, pain from the leg caused by degeneration of discs, spinal stenosis and spinal instability.

Spinal stability procedure involves entry into the vertebral (lumbar) foramina via two methods: Either through the conventional open surgical approach (where a larger incision is made at the middle of the back), or through minimally invasive surgical (MIS) approach. During the MIS procedure, the surgeon makes two small incisions on each side of the back (paramedian incisions) and special surgical tools, known as expandable tubular retractors, provide access to the spine without serious disruption of the muscle tissue. For easy visualization, the surgeon uses an endoscope.

Surgical procedure

This surgery takes approximately 1 to 2 hours or even more. This depends on how many vertebral bodies the surgeon has to fuse. Minimally Invasive TLIF requires a number of procedures, prior to the surgery and post-surgery. 

  • Prior to the surgery, the anesthesiologist will bring the patient to the operating room and put the patient to sleep before the operation. The anesthesiologist administers general anesthesia, this ensures the patient remains unconscious throughout the period of the surgery.
  • Two qualified nurses provide assistance for the performing surgeon, along with a surgical assistant. These health personnels help to reduce the workload on the surgeon, by providing the necessary surgical tools and professional assistance when required.
  • To begin the surgery, the surgeon makes one or two small incisions on either side of the patient’s back. The length of these incisions depends on the number of vertebral levels that require fusion. If fusion must occur at two or more vertebral levels, the length may increase.
  • Special retractors (expandable or non-expandable retractors) come into use. Placement of these retractors helps to expose the posterior aspect of the spine with minimum disruption of muscular tissue.
  • The next procedure involves removal of a small amount of bone and ligament(s) exerting pressure on the spinal canal.
  • The surgeon then removes the painful disc with special instruments and replaces it with a fusion device. This fusion device consists of a titanium box, filled with bone graft material.
  • Following replacement of the painful disc, placement of titanium screws and rods into the bones above and below the disc takes place. With the aid of x-ray guidance, the surgeon places the rods and screws through the small incisions made earlier. These tools aim to increase stability, which helps the fusion, heal.
  • To close the incision, the surgeon makes use of resorbable stitches placed beneath the skin.

 

Post Surgery

The patient rests in the recovery room for at least an hour. Shortly after, the physical therapists will ensure the patient has enough strength to carry out normal mobile activities (walking, climbing stairs). A number of patients choose to go home after the surgery, but some opt to stay overnight and go home the next morning.

Prescription of pain medications and muscle relaxants given to the patient will help to relieve post-operative pain and spasms. 

Manual labor that requires heavy lifting and frequent movements should cease for about 3 to 6 months before returning to these activities. Each post-op x-ray visit at 2 weeks, 3 months and 6 months will steadily observe the fusion rate. By the sixth month visit, solid fusion would have occurred. Patients can resume athletic/sports activities if x-ray shows solid fusion at 3 months.  

References 

Jeffords, P (2022). Minimally invasive TLIF (https://www.pauljeffordsmd.com/minimally-invasive-surgical-mis-tlif)

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