History and Evolution of the Minimally Invasive Transforaminal Lumbar Interbody Fusion

The minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a popular surgical technique for lumbar arthrodesis, widely considered to hold great efficacy while conferring an impressive safety profile through the minimization of soft tissue damage. This elegant approach to lumbar stabilization is the byproduct of several innovations throughout the past century. In 1934, Mixter and Barr's paper in the New England Journal of Medicine elucidated the role of disc herniation in spinal instability and radiculopathy, prompting sur-geons to explore new approaches and instruments to access the disc space. In 1944, Briggs and Milligan published their novel technique, the posterior lumbar interbody fusion (PLIF), involving continuous removal of vertebral bone chips and replacement of the disc with a round bone peg. The following decades witnessed several PLIF modifications, including the addition of long pedicle screws. In 1982, Harms and Rolinger sought to redefine the posterior corridor by approaching the disc space through the intervertebral foramen, estab-lishing the transforaminal lumbar interbody fusion (TLIF). In the 1990s, lumbar spine sur-gery experienced a paradigm shift, with surgeons placing increased emphasis on tissue -sparing minimally invasive techniques. Spurred by this revolution, Foley and Lefkowitz published the novel MIS-TLIF technique in 2002. The MIS-TLIF has demonstrated compa-rable surgical outcomes to the TLIF, with an improved safety profile. Here, we present a view into the history of the posterior-approach treatment of the discogenic radiculopathy, culminating in the MIS-TLIF. Additionally, we evaluate the hallmark characteristics, tech-nical variability, and reported outcomes of the modern MIS-TLIF and take a brief look at technologies that may define the future MIS-TLIF.

Automated summary

The minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a widely used surgical technique for lumbar arthrodesis, offering improved efficacy and safety through minimizing soft tissue damage. This article provides an overview of the historical development of posterior-approach treatment for discogenic radiculopathy, culminating in the introduction of MIS-TLIF. The characteristics, technical variability, and reported outcomes of modern MIS-TLIF are evaluated, along with a glimpse into potential future technologies.