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Minimally Invasive Transforaminal Lumbar Interbody Fusion

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Minimally Invasive Spine Surgery

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Abstract

The minimally invasive transforaminal lumbar interbody fusion approach is a versatile technique for the surgical treatment of a multitude of degenerative spinal maladies. It represents a robust and durable approach that provides three-column stability and significant pain relief. The TLIF technique involves a complete facetectomy and thereby allows for a more lateral exposure to the disk space obviating neural retraction. This chapter describes the indications and contraindications for the MIS TLIF approach. We describe the detailed technique necessary to successfully accomplish restoration of lordotic curvature. In order to enhance clinical outcomes, pearls and pitfalls pertaining to the approach are addressed. Also, possible surgical complications are herein described, and specific ways to avoid these errors are reported. Lastly, a review of the most current literature related to the MIS TLIF approach provides evidence of the advantages, feasibility, and applications of the technique.

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Disclosure

No funds were received in support of this work. No benefits in any form have been or will be received from any commercial party related directly or indirectly to the subject of this manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Ankur S. Narain, Fady Y. Hijji, Miguel A. Pelton, Sreeharsa V. Nandyala, Alejandro Marquez-Lara & Kern Singh

Authors
  1. Ankur S. Narain
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  2. Fady Y. Hijji
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  3. Miguel A. Pelton
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  4. Sreeharsa V. Nandyala
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  5. Alejandro Marquez-Lara
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  6. Kern Singh
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Corresponding author

Correspondence to Kern Singh .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Frank M. Phillips

  2. Texas Back Institute Texas Health Presbyterian Hospital Plano Scoliosis and Spine Tumor Center, Plano, TX, USA

    Isador H. Lieberman

  3. Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA

    David W. Polly Jr.

  4. Department of Neurological Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA

    Michael Y. Wang

Appendices

Quiz Questions

  1. 1.

    Which of the following is not a clinical indication for MIS TLIF?

    1. (a)

      L4–5 Degenerative disk disease

    2. (b)

      L3–4 Grade I spondylolisthesis

    3. (c)

      L3–4 Recurrent herniated disk

    4. (d)

      L4–5 Grade IV spondylolisthesis

  2. 2.

    Which of the following is true regarding the surgical anatomy for MIS TLIF?

    1. (a)

      The medial border of the anatomic working zone is composed of the traversing nerve root and thecal sac.

    2. (b)

      The musculature of the posterior spine has two layers: superficial and deep.

    3. (c)

      The Wiltse approach utilizes the natural plane between the multifidus and illiocostalis muscles.

    4. (d)

      The attachments of the paraspinal musculature on the contralateral side are not preserved in this approach.

  3. 3.

    Which of the following is not a proposed advantage of MIS TLIF compared to open spinal fusion approaches?

    1. (a)

      Reduced intraoperative blood loss

    2. (b)

      Reduced postoperative pain

    3. (c)

      Reduced operative time

    4. (d)

      Reduced long-term costs

  4. 4.

    Which of the following is true regarding the placement of instrumentation in MIS TLIF?

    1. (a)

      During pedicle screw cannulation, the K-wire should not pass the pedicle-vertebral body border anteriorly.

    2. (b)

      Use of interbody cages and pedicle screw fixation promotes axial load sharing.

    3. (c)

      The interbody cage should not pass the midline upon impaction.

    4. (d)

      Graft enhancers/osteobiologics and local bone graft should not be used concurrently within interbody cage devices.

Answers

  1. 1.

    d

  2. 2.

    a

  3. 3.

    c

  4. 4.

    b

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Narain, A.S., Hijji, F.Y., Pelton, M.A., Nandyala, S.V., Marquez-Lara, A., Singh, K. (2019). Minimally Invasive Transforaminal Lumbar Interbody Fusion. In: Phillips, F., Lieberman, I., Polly Jr., D., Wang, M. (eds) Minimally Invasive Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-19007-1_22

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  • DOI: https://doi.org/10.1007/978-3-030-19007-1_22

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-19006-4

  • Online ISBN: 978-3-030-19007-1

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