Classification of Minimally Invasive Techniques for Transforaminal Lumbar Interbody Fusion

Minimally-invasive techniques for transforaminal lumbar interbody fusion have been shown to reduce intra-operative blood loss, muscle injury, post-operative pain and length-ofstay and expedite recovery compared to the open technique [1-11]. The main drawback has been increased intra-operative radiation exposure due to reliance on bi-planar fluoroscopy that is required to compensate for diminished surgical exposure and visualization [12-18]. There are several surgical techniques for MIS-TLIF that provide a spectrum of exposures, ranging from minimal to moderate [3-11,19-25]. These are classified as percutaneous techniques, variously described at p-TLIF or MITLIF [3-11], and mini-open techniques, known as o-TLIF [19-25]. Recently, we described a modified mini-open technique, named MOTLIF, which offers an enhanced surgical exposure on par with an open exposure, thereby reducing the need for fluoroscopy [26]. An illustrated technique guide for MOTLIF is available at www.pakzaban.com/MOTLIF_technique_manual [27]. The distinguishing features of p-TLIF, o-TLIF and MOTLIF are outlined in Table 1. Here we compare and contrast these techniques with regard to exposure, decompression, interbody fusion, and pedicle screw placement.