In Orlando Medical Center “Touch of Health”, the process of minimally invasive TLIF is the following:
First phase. The doctor makes a 2.5 cm incision laterally at a distance of 4-5 cm from the centerline of the back. A mirrored incision is made for the insertion of transpedicular screws from the opposite side. Also, via this cut it is possible to loosen up the roots or distraction of the elements in transforaminal lumbar interbody fusion.
Second phase. The upper part of the lower arch and the inter-articular part of the arch is removed using Kerrison nippers. Removing the lateral part of the ligamentum flavum gives a way to get into the interbody space.
Third phase. The doctor excises the fibrous ring with a scalpel. Distraction is then performed to preserve the emerging root and allow a better view of the annulus fibrosus. After the remnants of the fibrous ring are excises, osteophytes and other growths are removed.
Fourth phase. The doctor uses a gauge or a cage simulator to determine the required height of the implant. The graft is placed strictly in the middle of the vertebral body. The transpeduicular fixation is performed by placing the barbell on the transpedicular screws and collecting the whole system. Drainage is installed in the wound, and then it is sewn up in layers.