22 Minimally Invasive Transforaminal Lumbar Interbody Fusion A 52-year-old woman presents to the clinic with right leg pain of 6-month duration. The patient denies any benefit from nonoperative management prescribed by her primary care physician, which included nonsteroidal anti-inflammatory drugs (NSAIDs), epidural steroid injections, and physical therapy. On physical examination, the patient exhibits a positive straight leg test and sensory deficits along the lateral leg. The patient also demonstrates mild weakness on great toe dorsiflexion. There is no noted hypo- or hyperreflexia or Babinski’s sign present. Lumbar radiographs are shown in Figs. 22.1 and 22.2. The patient’s radiographs and magnetic resonance imaging (MRI) are presented. The patient is subsequently scheduled to receive a minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) of the L5S1 disk space. • Lumbar disk herniations. • Compression of lumbar nerve roots. • Lumbar instability. • Access to the posterior lumbar spine with minimal blood loss and shortened patient recovery time. Fig. 22.1 Anteroposterior (a) and lateral (b) lumbar radiographs. There is moderate spondylosis of the L5–S1 disk space. Note the loss of disk height and narrowing of the neuroforamen. Fig. 22.2 Sagittal (a) and axial (b) T2-weighted MRI. There is significant foraminal and moderate central stenosis at the L5–S1 disk level. • Prone. • Landmarks identified through fluoroscopic imaging: – Spinous processes. – Pedicular line (lateral edge of the pedicle). • Superficial dissection: – The skin incision is made lateral to the midpedicular line (1.0 cm; Fig. 22.3a): ∘ Lateral fluoroscopy is utilized to confirm the location of the placed dilators at the correct level (Fig. 22.3b). ∘ There is no true internervous plane here, as the incision and entry point is made in between the paraspinal muscles, which are segmentally innervated.
22.1 Case Presentation
22.2 Indications
22.3 Positioning
22.4 Approach
Musculoskeletal Key
Fastest Musculoskeletal Insight Engine
