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Lumbar Minimally Invasive Transforaminal Interbody Fusion

What does Mini-Transforaminal Lumbar Interbody Fusion mean?

Here is the meaning of each word:

  1. Mini: Minimally invasive
  2. Transforaminal: through the small opening on the side of the spine where the spinal nerve leaves the spine (foramen)
  3. Lumbar: are of the spine located in the low back
  4. Interbody fusion: to mend two or more Vertebrae together

Altogether, “Mini-Transforaminal Lumbar Interbody Fusion” means to mend two or more Vertebrae in the spine together in a minimally invasive fashion through the foramen of the spine.

What is a Mini-Transforaminal Lumbar Interbody Fusion (Mini-TLIF)?

A Mini-TLIF is a surgery done minimally invasively using tubes to gain access to the spine. After the tubes are placed into the spine, areas of the lamina, pars interarticularis and facet joints are removed to relieve any compression of the spinal nerves. The majority of a degenerated disc is removed, and a bone or bone-like spacer placed in its place. Titanium screws and rods are placed to connect the vertebrae and bone grafting material is placed to promote a fusion.

Why is a Mini-Transforaminal Lumbar Interbody Fusion (Mini-TLIF) done?

This procedure is done to remove a degenerated disc and to relieve any nerve compression in the spine. The vertebrae are fused to provide stability.

What is the difference between a Mini-Transforaminal Lumbar Interbody Fusion and a regular Transforaminal Lumbar Interbody Fusion? 

A regular TLIF surgery is done as an open surgery, while the Mini-TLIF is minimally invasive. This has the potential advantage of less trauma to the spine, less blood loss and a faster recovery time.

How is a Mini-Transforaminal Lumbar Interbody Fusion done?

    1. An intravenous catheter (IV) is started and antibiotics are given
    2. The patient is taken to the Operating Room.
    3. The patient is placed on the back (supine) and a General Anesthetic is given.
    4. The patient is carefully place on the stomach (prone).
    5. The low back is cleaned with sterile surgical antiseptic solution.
    6. Sterile plastic sheets (drapes) are placed around the surgical site
    7. An X-Ray machine is used to locate the correct level in the spine.
    8. The surgeon makes a small cut (incision) over the spine.
    9. Dilating tubes are placed through the muscles in contact with the lamina bone.
    10. Over the dilating tubes a large working channel is placed to gain access to the important parts of the spine such as the lamina, pars interarticularis and facet joint.
    11. Small pieces of bone from the lamina, pars interarticularis and facet joints are removed to make sure all nerve compression is relieved.
    12. The dura and the spinal nerves are seen.
    13. The surgeon makes sure the dura and spinal nerves are free of compression.
    14. The area above the spinal nerve (foramen) is freed up.
    15. The core of the disc is removed.
    16. A spacer and bone or bone-like material (bone substitute) is placed into the disc space.
    17. With the help of an X-Ray machine, Titanium screws are placed into the pedicle (bone bridge between the body of the vertebra and the arch of the vertebra) of the vertebra above and below the disc from both sides.
    18. Titanium rods are secured to the screws and placed vertically between them.
    19. Bone and other materials are placed next to the screws and rods between the “wings” of the vertebrae (transverse processes).
    20. The tissues and skin are then closed.
    21. The patient is carefully turned on their back (supine) and awoken from Anesthesia.
    22. The patient is transported to the Recovery Room, where often more X-Rays are taken.

How long does a Mini-Transforaminal Lumbar Interbody Fusion procedure take?

It can take about 1.5-3 hours to complete this procedure for one spinal level.

What is the recovery like from a Mini-Transforaminal Lumbar Interbody Fusion procedure?

    1. The patient is usually admitted to the hospital for an overnight stay,
    2. A low back brace is sometimes used.
    3. A physical therapist may help with the initial recovery after surgery.
    4. After discharge from the hospital, specific instructions on activity are given. Lifting, bending, and twisting are often limited.
    5. A low back brace will often be recommended for several weeks or more after the surgery.
    6. The cuts (incisions) often take 4-6 weeks to heal depending on the type of Lumbar Fusion surgery.
    7. The surgeon will usually reevaluate the patient within several weeks. Often new X-Rays are taken at that time.
    8. The process of a full spinal fusion to develop may take 6 months to 1 year to complete. This does not mean that a patient would necessarily have pain during that process.

What benefits can patients gain from a Mini-Transforaminal Lumbar Interbody Fusion (Mini-TLIF)?

The benefit from a Lumbar Fusion depends on the original problem for which the spinal fusion was done for. Here are some possible improvements:

  1. Improved stability of the low back
  2. Improved low back pain after the healing is complete

Even after a complete bone fusion of the spine has occurred, some of the original symptoms may remain. Some patients develop new spine symptoms.