Minimally Invasive Transforaminal Lumbar Interbody Fusion

To begin the minimally invasive transforaminal lumbar interbody fusion, a small incision generally no more than one inch in length is made along the side of the middle of the low back. In order to pinpoint the exact portion of the spine where the procedure will be performed, a fluoroscope is used to project live xray images on a screen.

The surgeon will then insert a needle or thin wire through muscles and tissue to get to the spine. Dilators are then employed to separate muscle fibers along the wire, giving the surgeon access to the spine without actually cutting through muscles. First an initial dilator is used in order to lock the position, then larger dilators are used to create enough space for the procedure to be performed.

Over the dilators, a retractor device will be placed in order to both hold back the muscles and expand the surgical field. The retractor blades are opened and expanded using a hex screwdriver. Using these steps and instruments, the surgical field exposure is accomplished. The final step in beginning to guide the procedure is a microscope or endoscope being added to the retractor in order to provide live detailed imagery on a screen.

The surgeon is able to remove the entirety of the facet joint through the opening in the retractor. This will allow the surgeon access to the affected disc. Most of the affected disc will be removed by a grasping instrument. The removal of this disc relieves the pressure on the spinal nerves, which is what was causing the back or leg pain. In order to provide stability to the spine, a single bone graft is placed in the space where the disc formerly was.