Skip to main content
SpringerLink
Log in

How I do it: mini invasive transforaminal lumbar interbody fusion

  • How I Do it - Spine degenerative
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Minimally invasive approaches for lumbar fusion are aimed at reducing soft tissue injury in order to minimize surgical morbidity and facilitate recovery.

Method

Applied to lumbar fusion, such an approach is described as a mini-open transforaminal lumbar interbody fusion (TLIF). Important anatomical landmarks are reviewed. Indications, advantages, and limitations are discussed, and a step-by-step description of the procedure is presented.

Results

Decompression, fixation, and bone grafting can be achieved efficiently through this approach with lesser blood loss, shorter hospital stay, reduced rate of general complications, and infections as well as a lower readmission rate.

Conclusion

The mini-open TLIF technique, as presented here, is a safe and efficient procedure to achieve lumbar fusion with a reduced rate of complications related to surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Blondel B, Adetchessi T, Pech-Gourg G, Métellus P, Dufour H, Fuentes S (2011) Minimally invasive transforaminal lumbar interbody fusion through a unilateral approach and percutaneous osteosynthesis. Orthop Traumatol Surg Res 97:595–601

    Article  CAS  Google Scholar 

  2. Chen K, Chen H, Zhang K, Yang P, Sun J, Mo J, Zhou F, Yang H, Mao H (2019) O-arm navigation combined with microscope-assisted MIS-TLIF in the treatment of lumbar degenerative disease. Clin Spine Surg 32(5):E235–E240

    Article  Google Scholar 

  3. Farah K, Graillon T, Rakotozanany P, Pesenti S, Blondel B, Fuentes S (2018) Circumferential minimally invasive approach for low-grade isthmic spondylolisthesis: a clinical and radiological study of 43 patients. Orthop Traumatol Surg Res 104(5):575–579

    Article  CAS  Google Scholar 

  4. Ge DH, Stekas ND, Varlotta CG, Fischer CR, Petrizzo A, Protopsaltis TS, Passias PG, Errico TJ, Buckland AJ (2019) Comparative analysis of two transforaminal lumbar interbody fusion techniques: open TLIF versus Wiltse MIS TLIF. Spine (Phila Pa 1976) 44(9):E555–E560

    Article  Google Scholar 

  5. Hu ZJ, Fang XQ, Fan SW (2014) Iatrogenic injury to the erector spinae during posterior lumbar spine surgery: underlying anatomical considerations, preventable root causes, and surgical tips and tricks. Eur J Orthop Surg Traumatol 24:127–135

    Article  Google Scholar 

  6. Jin-Tao Q, Yu T, Mei W, Xu-Dong T, Tian-Jian Z, Guo-Hua S, Lei C, Yue H, Zi-Tian W, Yue Z (2015) Comparison of MIS vs. open PLIF/TLIF with regard to clinical improvement, fusion rate, and incidence of major complication: a meta-analysis. Eur Spine J 24(5):1058–1065

    Article  Google Scholar 

  7. Mummaneni PV, Rodts GE Jr (2005) The mini-open transforaminal lumbar interbody fusion. Neurosurgery. 57(4 Suppl):256–261 discussion 256-61

    PubMed  Google Scholar 

  8. Tumialan LM, Madhavan K, Godzik J, Wang MY (2019) The history of and controversy over Kambin’s triangle: a historical analysis of the lumbar transforaminal corridor for endoscopic and surgical approaches. World Neurosurg 123:402–408

    Article  Google Scholar 

  9. Wong AP, Smith ZA, Nixon AT, Lawton CD, Dahdaleh NS, Wong RH, Auffinger B, Lam S, Song JK, Liu JC, Koski TR, Fessler RG (2015) Intraoperative and perioperative complications in minimally invasive transforaminal lumbar interbody fusion: a review of 513 patients. J Neurosurg Spine 22:487–495

    Article  Google Scholar 

Download references

Acknowledgments

We thank Dr. Nathan Beucler for his contribution (Fig. 4) and Dr. Daniel May for proofreading.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Hôpital de La Timone, Assistance Publique - Hôpitaux de Marseille, Rue Saint-Pierre 264, Marseille, France

    Adrien Thomas May, Kaissar Farah, Mikael Meyer & Stéphane Fuentes

Authors
  1. Adrien Thomas May
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kaissar Farah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mikael Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stéphane Fuentes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adrien Thomas May.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Key points

1. Optimal patient positioning to maintain lordosis and prevent intra-abdominal compression of the veins.

2. Percutaneous pedicle screw placement on the contralateral side, K-wire left without screws on the side of the decompression to keep the tubular channel with the maximal possible working space.

3. The contralateral rod is used to distract temporarily the disc space to help with the decompression and the discectomy.

4. Wiltse approach through a 5 cm incision, 2.5 cm from the midline to reach the articular complex.

5. Use of an ultrasonic bone scalpel to easily and efficiently extirpate the joint with reduced risk of nerve injury.

6. Extensive decompression of the exiting nerve root with a pedicle to pedicle exposition

7. Localization of the anatomical landmarks of Kambin’s triangle.

8. Discectomy and complete endplate preparation with cartilage removal to maximize bone fusion.

9. Resection of the osteophytes of the lower endplate to facilitate cage insertion.

10. Ipsilateral pedicular screw placement and rod fixation in an adequate final position.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Spine degenerative.

Electronic supplementary material

The video illustrates the mini-open TLIF technique. A step-by-step description is detailed. (MP4 278028 kb).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

May, A.T., Farah, K., Meyer, M. et al. How I do it: mini invasive transforaminal lumbar interbody fusion. Acta Neurochir 163, 289–293 (2021). https://doi.org/10.1007/s00701-020-04388-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-020-04388-5

Keywords

Search

Navigation