Minimally Invasive Transforaminal Lumbar Interbody Fusion: Stabilization and Fusion using MISS technique (MIS TLIF)
Overview-Similar to conventional surgery, this MISS technique has two aspects – a. Fusion and B. Stabilization except that these are done through ‘key hole’ incisions. Percutaneous Pedicle Screw Fixation is done for stabilization and Interbody Fusion is achieved thorough a spacer filled with bone graft. These steps may be performed in conjunction with Micro- Endoscopic Decompression.
The primary indication of MIS TLIF is instability. Instability causes abnormal movement between bones giving rise to back pain, thus fusion is indicated. MIS TLIF is usually indicated in cases of instability due to degenerative causes like – Spondylolysis and Spondylolisthesis.
Scroll Down for Video Illustration
Surgery is usually suggested as the last resort. Failure of medical management, severe neurological compression causing weakness are usual circumstances when surgery is advised. After a thorough discussion (understanding risks and benefits) with the surgeon, the decision for surgery is taken.
The procedure is done under general anaesthesia. A tube is inserted in the throat to help breathing during anaesthesia. Patient is placed prone (face down) on the operating table. This technique is a continuation of Micro- Lumbar Decompression except that the facet joint is also removed and disc space is accessed. Disc is removed and the void is filled with bone graft to promote fusion.
In addition Stabilization is done with help of Percutaneous Pedicle Screw Fixation. This is done through ‘key hole’ incisions under C-arm (Intra operative X-ray) guidance. To improve accuracy, Navigation and Robotic techniques have been introduced to insert these screws with extreme precision. Once the screws and spacer is inserted, the ‘key holes’ are stitched up. After the surgery, patient may be shifted to ICU for observation or to the room depending upon the medical condition. Patient is usually made to walk on the same/ next day. Normally, 1-3 days of hospital stay is required. Once medical condition is stabilized, patient has adequate pain relief and mobilized, discharge is planned.
Patient is asked to follow up for stich removal between 2-3 weeks from surgery. A waterproof dressing may be applied in some patients so that bath can be taken. Patient is required to follow up at 6 weeks, 3 months, 6 months, 1 years and then annually after surgery for examination. Based on recovery – gradual increase in activities is advised.
Note: In a few cases, the surgeon may plan to convert the MISS surgery into TLIF is he/she feels that’s the best approach to achieve the goals of surgery.
With regards to complications, it has been shown that MISS has less infection rates. Similarly, in cases of Dural Tears, muscles usually fall back and hence, less chances of wound leaks and headaches. The profile of complications remain the same.
Disclaimer: The description of procedure is how usually a surgery is done. During the procedure, based on intra operative encounters which varies from patient to patient different steps may be performed.