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Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI TLIF)

Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI TLIF) is a surgical procedure used to replace degenerative discs, restoring the natural alignment of the spine.

In addition to relieving nerve pressure and thereby reducing, if not eliminating, pain, the goal of MI TLIF includes restoring proper lordosis and distributing weight to the front of the spine. By restoring proper curvature, the spine is able to dissipate the energy of gravity properly. This results in a great reduction in wear-and-tear and pain.


Disc degeneration is a complex and irreversible process. When a disc space collapses and no longer provides cushioning, it causes deformity to the adjacent functional discs. The force of gravity becomes more destructive, enabling increased wear and tear, arthritis, osteophytes, stenosis, and pain. Many treatment methods relieve pain temporarily but fail to target the underlying problem.

MI TLIF surgery addresses the root cause of the pain. For example, rather than simply “unpinching” a pinched nerve, MI TLIF addresses the issue of why the nerve was pinched in the first place. The procedure can restore disc space height, strengthen a weak joint, and restore spinal alignment. MI TLIF results in long-term pain relief because the overall spinal function is improved.

MI TLIF is helpful for patients with Degenerative Disc Disease (DDD), Adjacent Segment Degeneration (ASD), or Adult Spinal Deformity, and spinal instability. It is challenging to perform the surgery through a tube smaller than your index finger, but using a microscope for brain surgery enables the surgeon to hone micro spine surgery skills. This allows the surgeon to handle the nerves and spinal cord more delicately.

Other Benefits

MI TLIF provides relief from pain and a faster return to normal activity. Specifically the MI TLIF procedure:

  • Restores the patient’s spine to its natural alignment (increased lordosis, or natural gentle curve of the spine)
  • Allows for proper weight distribution (more energy efficient)
  • Corrects the underlying cause (treats beyond the pathologic or symptomatic level) align the spine.

Because the spine is accessed in a less invasive manner, the benefits of TLIF as opposed to traditional spinal surgery are extensive, including:

  • Smaller incisions
  • Less trauma to surrounding tissue
  • Less blood loss
  • Shorter hospital stay
  • Faster recovery

What is the process of MI TLIF surgery?

Patients first undergo an MRI, CAT Scan and/or X-Ray to determine the exact diagnosis. Surgical options are discussed with the patient, once the surgeon determines all the options.

MI TLIF surgery is performed through small incisions in the back. During the first portion of the surgery, the surgeon uses X-ray imaging to guide precise placement of screws to help fix the deformity and add strength. This also provides the surgeon with feedback on bone quality. The remaining portion of the surgery is performed using microarthroscopic techniques. The procedure requires less than two hours. Pictures may be taken to show the nerves before and after.

Patients can expect to be discharged the next day. Walking right away is possible because the spine is already stronger. The patient does not need to wait for fusion. Most patients return to full activity within six weeks.

What is the difference between MI TLIF and traditional spinal surgery?

The biggest difference between minimally invasive spinal surgery and traditional open spine surgery is how the surgeon gets to the pathology. Traditional surgery requires a large incision on the patient’s back to remove soft tissue and push aside surrounding nerves to gain access to the bony plates (laminectomy) that protect and strengthen the spine.

Traditional surgery also requires more time with additional instrument passes just to get to the disc space. This results in a greater risk for infection and increased blood loss. The patient is very limited post-operatively while tissue heals.

MI TLIF back surgery requires fewer steps, and each step advances the goal of surgery. Instead of just removing bone and disc and weakening the spine, MI TLIF strengthens and restores the alignment of the spine: strengthen, add, and restore.
Quality outcome data and patient satisfaction data demonstrate this. The need for more surgery or return to the hospital emergency room after surgery is significantly reduced.
If the human body is perfect, that means every piece of tissue has a purpose. MI TLIF respects this as it is a more humble and natural approach.

For more on The Brain + Spine Center experience, watch these videos of actual patient procedures and testimonials.

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Have you had an MRI in the last 12 months?

It is just wonderful to feel some relief.
– BG