Minimally Invasive TLIF

History

A 75 year old female presented complaining of five months of progressive lower back and bilateral lower extremity pain, left greater than right. At the time of presentation, her symptoms were severe and debilitating preventing her from standing for periods longer than ten minutes.

She had tried formal physical therapy, therapeutic massage, epidural steroid injections, oral pain medications (including narcotics and NSAIDs) and lumbar spine activity modification.

Examination

On examination, she was found to have painful, restricted lumbar range of motion and positive sciatic nerve stretch testing of the left lower extremity.

Diagnosis

She was diagnosed with a L4-5 grade 1 degenerative spondylolisthesis with facet arthritis and mild-to-moderate spinal stenosis.

Her pre-operative MRI showed: Severe L4-5 foraminal stenosis resulting in compression of the exiting L4 nerve root and sciatica. It also showed L4-5 Spinal Stenosis and facet joint arthritis with fluid in the right facet joint.

Selected Treatment

The patient underwent a minimally invasive Transforaminal Lumbar Interbody Fusion (TLIF ) and Laminectomy. The Minimally Invasive TLIF was performed with central interbody cage placement. A Minimally Invasive Laminectomy was also performed to decompress the stenosis.

As shown above the MIS TLIF and Laminectomy are performed through a tubular retractor 22-26mm in diameter.

This procedure allowed for reduction of the slippage at L4-L5 and realignment of the spine. It also allowed for decompression L4-5 neuroforaminal stenosis so that there was space created for the exiting L4 nerve root.