History and Evolution of the Minimally Invasive Transforaminal Lumbar Interbody Fusion

Abstract

The minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a popular surgical technique for lumbar arthrodesis, widely considered to hold great efficacy while conferring an impressive safety profile through the minimization of soft tissue damage. This elegant approach to lumbar stabilization is the byproduct of several innovations throughout the past century. In 1934, Mixter and Barr’s paper in the New England Journal of Medicine elucidated the role of disc herniation in spinal instability and radiculopathy, prompting surgeons to explore new approaches and instruments to access the disc space. In 1944, Briggs and Milligan published their novel technique, the posterior lumbar interbody fusion (PLIF), involving continuous removal of vertebral bone chips and replacement of the disc with a round bone peg. The following decades witnessed several PLIF modifications, including the addition of long pedicle screws. In 1982, Harms and Rolinger sought to redefine the posterior corridor by approaching the disc space through the intervertebral foramen, establishing the transforaminal lumbar interbody fusion (TLIF). In the 1990s, lumbar spine surgery experienced a paradigm shift, with surgeons placing increased emphasis on tissuesparing minimally invasive techniques. Spurred by this revolution, Foley and Lefkowitz published the novel MIS-TLIF technique in 2002. The MIS-TLIF has demonstrated comparable surgical outcomes to the TLIF, with an improved safety profile. Here, we present a view into the history of the posterior-approach treatment of the discogenic radiculopathy, culminating in the MIS-TLIF. Additionally, we evaluate the hallmark characteristics, technical variability, and reported outcomes of the modern MIS-TLIF and take a brief look at technologies that may define the future MIS-TLIF.

Spinal Canal Remodeling and Indirect Decompression of Contralateral Foraminal Stenosis After Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion

“…Overall, minimally invasive transforaminal interbody fusion such as EPTLIF has promising results and potential in being treatment of choice for fusion with better understanding of technique and technology of interbody cages. 29 There are a few limitations of this study. The surgeon was not blinded to the patient's symptoms and were given the option to decide if the patient requires bilateral decompression, ipsilateral decompression or cage insertion alone without any decompression during the surgery.…”

Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using Double Cages: Surgical Techniques and Treatment Outcomes

“…tubular retractor has evolved to reduce the approach related complications in traditional open surgeries, with decreased surgical morbidity, decreased length of hospital stay, and improved outcomes. 3,4 However, MIS-TLIF still poses a great challenge for the surgeon in neural decompression, removal of disc, and endplate preparation due to limited anatomic visualization and decreased haptic feedback. 2,4 Compared to the LIF via anterior approach, TLIF has a significant higher rate of cage subsidence, which may be attributed to the smaller cage footprint and endplate violation.…”

Surgical treatment of spondylolisthesis by oblique lumbar interbody fusion and transpedicular screw fixation: Comparison between conventional double position versus navigation-assisted single lateral position

“…There are various surgical methods for treating spondylolisthesis, which can be broadly classified as ventral or dorsal approaches based on the direction of approach to the intervertebral disc space [3,10,17]. OLIF is a minimally invasive ventral approach that involves inserting a wide cage into the disc space [3,15,[18][19][20][21][22][23]. Unlike the trans-psoas approach, surgeons approach the disc space anterior to the psoas muscle in OLIF to minimize the risk of injury to the muscle and lumbosacral nerve plexus [4].…”