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How I do it: mini invasive transforaminal lumbar interbody fusion

Acta Neurochirurgica volume 163, pages 289–293 (2021)Cite this article

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.

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Acknowledgments

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

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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
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  2. Kaissar Farah
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  3. Mikael Meyer
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  4. Stéphane Fuentes
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Corresponding author

Correspondence to Adrien Thomas May.

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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.

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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).

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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

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

Keywords

  • Mini-open
  • Mini invasive
  • Transforaminal interbody fusion
  • TLIF