Minimally invasive TLIF is a type of spinal surgery designed to relieve pain in your lower back and legs. The procedure involves fusing (joining) two or more vertebrae in your lower spine to stabilize them and reduce movement that may be causing pain. The “minimally invasive” part means that the surgery is done through small incisions with special instruments, which leads to less tissue damage, quicker recovery, and smaller scars.

Why is MIS TLIF Performed?

You might need a TLIF if you have conditions like degenerative disc disease, spondylolisthesis (where one vertebra slips over another), or spinal stenosis (narrowing of the spinal canal), and if other treatments like medications, physical therapy, or injections haven’t provided enough relief.

How is the Procedure Done?

Anesthesia
You’ll be under general anesthesia, so you’ll be asleep and won’t feel anything during the surgery. You will be laying face down so that the spine be accessed from the back.

Small Incisions
A/Prof Buckland will make two small incisions in your back, usually less than an inch long.

Accessing the Spine
Through these small incisions, A/Prof Buckland will use special tools and a tube-like retractor to gently move muscles and tissues aside to reach your spine without cutting them. This minimizes damage to the surrounding muscles. A high powered microscope is used to improve visualisation and accuracy of the decompression and dissection.

Decompression of Nerves
The nerves are ‘freed up’ using specialised instruments to ensure that the leg pain is resolved. These nerves are within the spinal canal (traversing nerve) and foramen (exiting nerve). The exiting nerve is then gently retracted to allow access to the disc for removal and cage insertion.

Removing the Damaged Disc:
The damaged intervertebral disc, which is the cushion between your vertebrae, will be partially or completely removed to relieve pressure on your spinal nerves and prepare the disc for fusion.

Inserting Cage and Bone Graft
A cage (spacer) filled with bone graft material is then placed in the space where the disc was removed. This graft helps to restore the normal disc height and alignment, and to encourage the two vertebrae to grow together (fuse) into one solid bone over time.

Stabilizing the Spine
Metal screws and rods are inserted via the same incisions to hold the vertebrae in place while the fusion occurs. These implants will remain in your body permanently, helping to keep your spine stable.

Closing the Incisions
The retractors are removed, allowing the muscles to move back into place, and then the small incisions are closed with sutures.

Recovery

• Hospital Stay: You’ll likely stay in the hospital for a day or two. Some patients even go home the same day.
• Pain Management: You’ll have some pain after surgery, but it’s usually less severe than with traditional surgery, and pain medications will help manage it. Most people can cease the pain medication in the following 2-4 weeks.
• Physical Therapy: You’ll start walking and doing light activities soon after surgery. Physical therapy will help you regain strength and mobility.
• Full Recovery: Recovery time varies, but most people return to light activities within a few weeks and more vigorous activities within 3-6 months.

Benefits of Minimally Invasive TLIF over Open TLIF

• Smaller Incisions: This means less muscle damage, less pain after surgery, and smaller scars.
• Quicker Recovery: You can expect to be up and moving sooner than with traditional open surgery.
• Lower Risk of Infection: The smaller incisions reduce the risk of infection.

Risks and Considerations

As with any surgery, there are risks, including infection, bleeding, or nerve damage, but these are generally lower with minimally invasive techniques. It’s also important to follow your surgeon’s instructions closely during recovery to ensure the best outcome. Not all patients or pathologies are suitable for MIS TLIF, and A/Prof Buckland will choose the procedure that best treats your specific condition and anatomy.

Patient-Reported Outcomes and Results

Lumbar Fusion Surgery significantly improves function and pain in the majority of patients. Learn more about A/Prof Buckland’s patient-reported outcomes of 1-2 level lumbar fusion below.