MIS TLIF (Minimally Invasive Transforaminal Lumbar Interbody Fusion)

Overview

MIS TLIF stands for Minimally Invasive Transforaminal Lumbar Interbody Fusion. It is a modern, less disruptive approach to traditional TLIF that achieves spinal fusion through small incisions rather than a large midline incision. The procedure is designed to treat conditions like spondylolisthesis, degenerative disc disease, recurrent disc herniations, and foraminal stenosis that require spinal stabilization. By approaching the disc space through the foramen (the natural opening where the nerve exits), Dr. Basques can remove the damaged disc, place a spacer (cage) filled with bone graft, and stabilize the spine with screws and rods — all through small paraspinal incisions. Combined with robotic guidance, MIS TLIF offers sub-millimeter accuracy with minimal muscle trauma. Dr. Basques is one of the few surgeons in New England combining MIS TLIF with robotic navigation and is the Director of MIS Spine Surgery at Brown University.

How It Works

The patient is positioned face-down under general anesthesia. Using intraoperative X-ray or robotic navigation, Dr. Basques maps the exact surgical level. Two or three small incisions (about 2–3 cm each) are made on either side of the midline. Tubular dilators are sequentially inserted, gently spreading the paraspinal muscles apart without cutting them. Through these working channels, Dr. Basques removes the facet joint on one side to access the disc space. The damaged disc is removed, and the disc space is prepared. A cage packed with bone graft material is precisely placed into the disc space. Pedicle screws and rods are inserted through the same small incisions to provide immediate stability. The entire procedure typically takes 2–3 hours. The dilators are removed, muscles fall back into place, and the incisions are closed with a few stitches.

Benefits

Who Is a Candidate?

Ideal candidates have lumbar spondylolisthesis (grades I–II), degenerative disc disease with mechanical low back pain, recurrent disc herniation, or foraminal stenosis requiring fusion. Candidates should have failed 6 months of non-surgical treatment. Factors like obesity or prior surgery do not necessarily preclude MIS TLIF. Dr. Basques evaluates each patient's imaging, symptoms, and overall health to determine if MIS TLIF is the optimal approach.

Recovery & Aftercare

Most patients stay in the hospital for 1–2 days. Walking begins the day after surgery. Light activities resume within 2 weeks. Return to desk work is typically 3–4 weeks. Physical labor jobs require 3–4 months. No heavy lifting or bending for the first 6–8 weeks. A back brace may be recommended for the first few weeks. Fusion takes 6–12 months to become fully solid. Dr. Basques provides detailed activity restrictions and a phased return-to-activity plan.

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