Q: What makes the TLIF procedure stand out?

Dr. Navin Subramanian: The TLIF is a standard technique that has been described in literature as a variation of the posterior interbody fusion where you approach the spine diagonally through a neuroforamen to access the disc space through a posterior approach. The minimally invasive surgery is a newer technique where the surgeon uses fluoroscopy to do the procedure. Because the approach is less invasive, it decreases infection rates and blood loss and allows the patient a quicker return to work. It\’s a new variation on a classic technique and I think a lot of surgeries are moving in that way.

Q: What do spine surgeons need to know when performing TLIF as a minimally invasive procedure?

The most important thing to understand is the anatomy. In training, I learned the procedure for the open technique, which I did several times before trying the minimally invasive technique. Surgeons who want to gain a comprehensive understanding of the anatomy while looking through a microscopic should begin by performing discectomies and treatment for disc herniations because there is a similar approach when treating these conditions. Endoscopy is also a technique that has gained some acceptance in the past. However, it has fallen out of favor because of complications and a steep learning curve.

Q: How are the outcomes different when surgeons perform the minimally invasive TLIF?

NS: There is some literature that suggests that the long term outcomes between open and minimally invasive procedures for TLIF are the same. Initially, when I first started performing the minimally invasive technique and saw the long-term outcomes were the same, I wasn\’t really sold on the procedure. However, the whole purpose of the minimally invasive procedures is to increase patient comfort and decrease postoperative pain and infection rates. I saw literature on some of these benefits and then saw the same benefits for my patients. I realized the importance of these benefits in my practice.

Q: Can surgeons perform this in an outpatient setting?

NS: There are some surgeons are performing minimally invasive TLIF as outpatient procedures. I prefer to perform these cases with a 23 hour postoperative stay. Therefore, some of these procedures can be done in ambulatory surgery centers that have 23 hour observation. Because there is less muscle damage, patients can begin moving around and return home earlier than with open surgeries.