Minimally Invasive Trans-foraminal Lumbar Interbody Fusion (MI-TLIF): Technique, Tips and Tricks.

Volume 2 | Issue 2 | October 2021-March 2022 | page: 60-64 | Sanjeev Asati, Saijyot Raut, Vishal Kundnani, Amit Chugh, Ameya Rangekar, Praveen VNR Goparaju
DOI: 10.13107/bbj.2022.v02i02.023

Authors: Sanjeev Asati [1], Saijyot Raut [1], Vishal Kundnani [1], Amit Chugh [1], Ameya Rangekar [1], Praveen VNR Goparaju [1]

[1] Department of Spine Surgery, Bombay Hospital & Medical Research Centre, Mumbai, Maharashtra, India.
[2] Mumbai Spine Scoliosis and Disc Replacement Centre, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Saijyot Raut,
Clinical spine fellow, Bombay Hospital & Medical Research Centre & Mumbai Spine Scoliosis and Disc Replacement Centre, Mumbai, Maharashtra, India.


Surgical interbody fusion is the main stay of treatment in many lumbar pathologies. Of these, transforaminal lumbar interbody fusion has progressively gained popularity among fusions due to its safety and satisfactory results. With the ever-ending evolution of technological advancements enabled spine surgeons to embrace minimally invasive surgeries mainly due to focal nature of the pathology. Tubular retractors have been tried and tested with very good results when used with microscopic magnification. They helps in surgical decompression and fusion through transforaminal approach with minimal footprint and have proven their versatility by delivering excellent outcomes. Near total bloodless surgery, better cosmesis, decreased hospital stay, lower pain score, early return to work, are some other proven advantages with minimally invasive transforaminal interbody fusion MIS-TLIF. However, high procedural costs and longer trajectory of learning is restraining many surgeons from adapting this technique over time tested open procedures. In this report the authors discuss about the nuances of the surgical procedure, tips and tricks to provide a comprehensive insight and better understanding.

Keywords: MIS-TLIF, Minimally invasive spine surgery, Transforaminal lumbar interbody fusion.


1. Stonecipher T, Wright S (1989) Posterior lumbar interbody fusion with facet screw fixation. Spine 14:468–47.
2. Fraser RD (1995) Interbody, posterior, and combined lumbar fusions. Spine 20:S167–S177.
3. Harms J, Jeszenszky D (1998) The unilateral transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol 6:88–99.
4. Foley KT, Holly LT, Schwender JD (2003) Minimally invasive lumbar fusion. Spine 15(suppl):26–35.
5. Jin-Tao Q, Yu T, MeiW, et al. Comparison of MIS vs. open PLIF/ TLIF with regard to clinical improvement, fusion rate, and incidence of major complication: a meta analysis. Eur Spine J. 2015;24:1058-1065.
6. Khan NR, Clark AJ, Lee SL, Venable GT, Rossi NB, Foley KT. Surgical outcomes for minimally invasive vs open transforaminal lumbar interbody fusion: an updated systematic review and metaanalysis. Neurosurgery. 2015;77:847-874.
7. Adogwa O, Parker SL, Bydon A, Cheng J, McGirt MJ. Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion: 2-year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech. 2011;24:479-484.
8. Gu G, Zhang H, Fan G, et al. Comparison of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease. Int Orthop. 2014;38:817-824.
9. Kulkarni AG, Patel RS, Dutta S. Does minimally invasive spine surgery minimize surgical site infections? Asian Spine J. 2016;10: 1000-1006.
10. Kim KT, Lee SH, Suk KS, Bae SC. The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine (Phila Pa 1976) 2006;31:712-6.
11. Kim DY, Lee SH, Chung SK, Lee HY. Comparison of multifidus muscle atrophy and trunk extension muscle strength: Percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976) 2005;30:123-9.
12. Shunwu F, Xing Z, Fengdong Z, Xiangqian F (2010) Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine 35:1615–1620.
13. Wang HL, Lu FZ, Jiang JY, Ma X, Xia XL, Wang LX (2011) Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery: a prospective randomized clinical trial. Chin Med J (Engl) 124:3868–3874.
14. Kim CW, Lee YP, Taylor W, Oygar A, Kim WK (2008) Use of navigation-assisted fluoroscopy to decrease radiation exposure during minimally invasive spine surgery. Spine J 8:584–590.
15. Tjardes T, Shafizadeh S, Rixen D, Paffrath T, Bouillon B, Steinhausen ES, Baethis H (2010) Image-guided spine surgery: state of the art and future directions. Eur Spine J 19:25–45.

How to Cite this Article: Asati S, Raut S, Kundnani V, Chugh A, Rangekar A, Goparaju P VNR | Minimally Invasive Trans-foraminal Lumbar Interbody Fusion (MI-TLIF): Technique, Tips and Tricks. | Back Bone: The Spine Journal | October 2021-March 2022; 2(2): 60-64.


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Minimal Invasive Transforaminal Lumbar Interbody Fusion for Isthmic Spondylolisthesis with Nerve Root Anomaly in Young Adult Male Football Player: Case Report

Volume 2 | Issue 1 | April-September 2021 | page: 43-47 | Umesh Srikantha, Yadhu K Lokanath, Akshay Hari, Ravi Gopal Varma

Authors: Umesh Srikantha [1], Yadhu K Lokanath [1], Akshay Hari [1], Ravi Gopal Varma [1]

[1] Department of Neurosurgery, Centre of Excellence: Brain & Spine Aster CMI, Bengaluru, Karnataka, India.

Address of Correspondence
Dr. Yadhu K Lokanath,
Consultant Neurosurgeon, Department of Neurosurgery, Centre of Excellence: Brain & Spine Aster CMI, Bengaluru, Karnataka, India.


Interbody fusion is preferred surgical treatment for various symptomatic pathologies of lumbar spine and spondylolisthesis is one of the commonest indication. Goal is to achieve adequate bony and neural decompression, disc height restoration, deformity correction and good interbody fusion. Numerous techniques and approaches have been designed, minimal invasive tubular transforminal interbody fusion is widely accepted among them. In any case pre-operative planning and identifying any anatomical variation is prerequisite before surgery. In this article, we report, 22-year male football player, presenting with worsening low back pain, left radicular pain with neurogenic claudication. Radiographs revealed a L5-S1 Meyerding grade I isthmic spondylolisthesis with L5-S1 left sub articular disc protrusion with narrowing of lateral recess on left side and no evidence of lumbosacral nerve root anomalies on magnetic resonance imaging. Patient was planned for minimal invasive L5-S1 transforaminal interbody fusion, intraoperatively, Type 3 Neidre and Macnab root anomaly was identified, patient successful underwent interbody fusion with no acute intraoperative or postoperative complications. In follow up period, patient had no radicular pain. In our article, we summarize the incidence, classification of nerve root anomaly along with intra operative strategy for interbody fusion in presence of root anomaly and report this rare twin anomaly.
Keywords: Isthmic spondylolisthesis, nerve root anomaly, MIS TLIF, young football player.


1. Trimba R, Spivak JM, Bendo JA. Conjoined nerve roots of the lumbar spine. Spine J 2012;12:515-24.
2. Postacchini F, Urso S, Ferro L. Lumbosacral nerve-root anomalies. J Bone Joint Surg Am 1982;64(5):721-9.
3. Babayeva N, Torgutalp SS, Dönmez G Et al. Spondylolysis in an Adolescent Soccer Player. Austin Sports Med. 2017; 2(1): 1013.
4. Scuderi GJ, Vaccaro AR, Brusovanik GV et al. Conjoined lumbar nerve roots: a frequently underappreciated congenital abnormality. J Spinal Disord Tech 2004; 17:86-93.
5. Kadish LJ, Simmons EH. Anomalies of the lumbosacral nerve roots. An anatomical investigation and myelographic study. J Bone Joint Surg Br 1984; 66:11–16.
6. Song SJ, Lee JW, Choi JY et al. Imaging features suggestive of a conjoined nerve root on routine axial MRI. Skeletal Radiol 2008;37:133-8.
7. Kang CH, Shin MJ, Kim SM et al. Conjoined lumbosacral nerve roots compromised by disk herniation: sagittal shoulder sign for the preoperative diagnosis. Skeletal Radiol 2008;37:225-31.
8. Davidson D,Rowan R , Reilly C : Lumbosacral Nerve Root Anomaly Associated With Spondylolisthesis in an Adolescent: A Case Report and Review of the Literature : SPINE Volume 31, Number 19,2006 ; pp E718 –E721
9. Hutton WC, Cyron BM, Spondylolysis. The role of the posterior elements in resisting the intervertebral compressive force. Acta Orthop Scand 1978; 49:604–609
10. Ganju A: Isthmic spondylolisthesis: Neurosurg Focus 2002 Jul 15;13(1):E1.
11. Moskowitz A: Transforaminal lumbar interbody fusion. Orthop Clin North Am 2002; 33:359–366
12. Shane MB, Mina GS , Kryzanski J et al : Nerve root anomalies: implications for transforaminal lumbar interbody fusion surgery and a review of the Neidre and Macnab classification system : Neurosurg 2013 ; Focus 35 (2):E9

How to Cite this Article: Srikantha S, Lokanath YK, Hari A, Varma RG | Minimal Invasive Transforaminal Lumbar Interbody Fusion for Isthmic Spondylolisthesis with Nerve Root Anomaly in Young Adult
Male Football Player: Case Report | Back Bone: The Spine Journal | April-September 2021;
2(1): 43-47.


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