Minimally Invasive

Transforaminal
Lumbar Interbody Fusion
Bob Irfan syahputra
• The MIS-TLIF was introduced by Foley et al. in 2003 as a way to mitigate the collateral damage
to supporting anatomical structures seen in open TLIF.
• Despite an initial steep learning curve, experience with MIS-TLIF grew rapidly, and the procedure
has become widely accepted. Like other minimally invasive, muscle-sparing techniques, MIS-
TLIF is associated with less blood loss, decreased risk of infection, faster return to ambulation,
and shorter hospitalization. Also, especially important in the era of value-based care, MIS-TLIF
has been shown to be more cost-effective when compared to open TLIF

• Today, technologies such as image guidance, surgical robotics, expandable interbody spacers, and
advanced spacer materials have only increased the ease and effectiveness of MIS-TLIF. Here we
discuss indications, technical nuances, and outcomes of MIS-TLIF.
Indications
MIS-TLIF has the same indications as its open analog, namely,
spondylolisthesis/ instability, unilateral foraminal stenosis, recurrent
disc herniation, focal kyphotic deformity, and discogenic pain.
Due to the significant reduction in wound/incision size, it is arguably a
superior choice for obese and healing-challenged patients (i.e.,
diabetes mellitus, rheumatologic disease, etc.)
Operation Technique
Operation Technique
Operation Technique
Operation Technique
Operation Technique
Operation Technique
Multilevel Cases
It is possible to perform multi-level MIS TLIF. Two level cases are quite
common, and, with the tubular retractor method, the surgeon simply
dilates and places the tube over each of the facets for the levels to be
fused.

With the pedicle screw-based systems, the blades on the pedicles are
simply rotated 180° to treat each level. Three or more levels are
possible but not commonly done. Frequently, MIS-TLIF will be done at
L5/S1 as a second phase while placing the pedicle screws to back up
lateral lumbar interbody fusions (LLIF) of L4/5 and more cephalad levels
Outcomes and Complications
MIS-TLIF has been proven to be a safe and effective alternative to open
TLIF. Reduced blood loss, infection rate, hospital stay, postoperative
narcotic usage, and return to work have been demonstrated in the
literature. Fusion rates have been shown to be comparable to
traditional fusion techniques
The limited incision size and muscle sparing nature of this procedure
help minimize wound complications, especially the obese and diabetic
Complications of MIS-TLIF are in general similar to those of its open
analog and include pseudoarthrosis, hardware failure, cerebrospinal
fluid leak, subsidence, neural injury, and vascular/visceral injury.
HATUR
NUHUN