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The neurosurgeon I met who is going to fuse my lumbar spine showed me the handful of "hardware" that will replace the disc and hold everything together. I know they are going to enter the spine from the side but how in the world do they get all that stuff inside (and in place) with only a two inch incision?

For almost 30 years surgeons have been fusing the lumbar spine using the popular transforaminal lumbar interbody fusion (TLIF) technique. The surgeon approaches the spine from the side rather than from the front (anterior approach) or the back (posterior approach). The procedure was first done with an open incision approach called an open transforaminal lumbar interbody fusion or TLIF. This procedure required cutting through the spinal muscles to get to the spine. Trauma to the muscles and soft tissues with this method created lots of complications with infection, bleeding, and poor wound healing. Over time, surgical technology and equipment have improved and advanced so that the procedure could be done as a minimally invasive (MI) approach. Minimally invasive means a very small incision is made. In a minimally invasive TLIF (referred to as mTLIF), a long thin tube is passed down through the skin, fascia, and muscle down to the spine. It is not necessary to dissect (cut through) all these layers of soft tissue. Surgical instruments and hardware (cages, screws) used to fuse the spinal segment are passed through this tubular retractor system. The surgeon also uses 3-D navigational (surgical) tools that allow him or her to see the correct pathway and avoid injury to nerve tissue. Fusion rates are fairly equal between the open and minimally invasive approaches. And according to a recent meta-analysis, the complication rate for the minimally invasive transforaminal lumbar interbody fusion is also less.

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