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 surgeons 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, establishing the transforaminal lumbar interbody fusion (TLIF). In the 1990s, lumbar spine surgery experienced a paradigm shift, with surgeons placing increased emphasis on tissuesparing minimally invasive techniques. Spurred by this revolution, Foley and Lefkowitz published the novel MIS-TLIF technique in 2002. The MIS-TLIF has demonstrated comparable 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, technical variability, and reported outcomes of the modern MIS-TLIF and take a brief look at technologies that may define the future MIS-TLIF.
Citations
Citations to this article as recorded by
Comparing the Effect of Spinal Versus General Anesthesia on Postoperative Opioid Use in Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Patient Matched Study Harshvardhan G. Iyer, Jesus E. Sanchez-Garavito, Jorge Rios-Zermeno, Andrew P. Roberts, Juan P. Navarro Garcia de Llano, Loizos Michaelides, Jimena Gonzalez-Salido, Benjamin F. Gruenbaum, Elird Bojaxhi, Oluwaseun O. Akinduro, Ian A. Buchanan, Kingsley O. Journal of Clinical Medicine.2026; 15(2): 781. CrossRef
Uniportal endoscopic posterior lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion for elderly patients with lumbar degenerative diseases: a retrospective comparative study of reduced surgical trauma and accelerated early Juanming Lan, Bin Cao, Yongpeng Lin, Weixiong Hu, Rui Lin, Lulu Li, Bolai Chen Frontiers in Surgery.2026;[Epub] CrossRef
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Objective To assess change in Patient-Reported Outcome Measures (PROM) as predictors for revision lumbar decompression (LD).
Methods Patients who underwent primary, single or multilevel LD were retrospectively reviewed. Patients were categorized according to whether or not they underwent revision LD within 2 years of the primary procedure. Visual analogue scale (VAS), Oswestry Disability Index (ODI), 12-item Short Form Health Survey and 12-item Veterans RAND physical component score (SF-12 PCS and VR-12 PCS), and Patient-Reported Outcome Measurement Information System physical function (PROMIS-PF) were recorded. Delta PROM scores were evaluated for differences between groups and as a risk factor for a revision LD.
Results The study included 135 patients, 91 undergoing a primary procedure only and 44 undergoing a primary and revision procedure. Matched patients did not demonstrate any significant differences in demographics or perioperative characteristics. Patients who underwent a revision had a mean time to revision of 7.4 ± 5.7 months. Primary cohort significantly improved for all PROMs (all p < 0.05), while the primary plus revision cohort significantly improved for VAS back, ODI, and PROMIS-PF (all p < 0.05). However, cohorts differed in VAS back and PROMIS-PF (p < 0.05). Delta PROMs were not a significant risk factor for revision except at 6 months for PROMIS-PF (p = 0.024).
Conclusion LD has been associated with reliable outcomes, but early identification of patients at risk for revision is critical. This study suggests that tools such as PROMIS-PF may serve a role in predicting who is at risk and the 6-month follow-up period may be valuable for counseling patients who are not experiencing improvement.
Citations
Citations to this article as recorded by
Use of the Patient-Reported Outcomes Measurement Information System (PROMIS) Outcome Measures in Lumbar Decompression Surgery: A Systematic Review Harneet K Cheema, Manraj S Cheema, James Gomes Cureus.2026;[Epub] CrossRef
Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study Robert J. Trager, Jordan A. Gliedt, Collin M. Labak, Clinton J. Daniels, Jeffery A. Dusek BMC Musculoskeletal Disorders.2024;[Epub] CrossRef
Screening patients requiring secondary lumbar surgery for degenerative lumbar spine diseases: a nationwide sample cohort study Hangeul Park, Juhee Lee, Yunhee Choi, Jun-Hoe Kim, Sum Kim, Young-Rak Kim, Chang-Hyun Lee, Sung Bae Park, Kyoung-Tae Kim, John M. Rhee, Chi Heon Kim Scientific Reports.2024;[Epub] CrossRef
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