Can you explain this to me? I had what the surgeon calls minimally invasive lumbar fusion at the L4-L5 level. The surgeon assures me the full procedure was done but all I see are two tiny incisions. They aren't even an inch long. How do they do dig around in there, remove the disc, jack open the vertebra and stick the cage in there [at least that's how I understand what they did]?
You are fairly accurate in your description of the steps your surgeon performed to complete what's called a transforaminal interbody lumbar fusion (TLIF).The TLIF technique is used to avoid the problems that come with entering the spine from the front (anterior approach).
Transforaminal means the surgeon gains access to the spine from the back and side. The surgeon makes a posterolateral incision and removes one of the facet (spinal) joints so the disc can be taken out.
Interbody describes how the fusion is circumferential (all the way around and from front-to-back). Once the disc is removed, the two vertebrae are distracted or pulled apart gently and a special device called an interbody spacer is slid into the disc space.
The spacer helps restore normal disc height. A normal disc space takes pressure off the spinal nerve roots as they leave the spinal cord and pass through the opening formed by the vertebral bones.
When performing a minimally invasive TLIF, the surgeon uses a special tool called a tubular retractor system. A small incision is made through the skin and soft tissues to allow the placement of a hollow tube down to the spine. The tube holds the skin and soft tissues open. There is less risk of scar tissue formation using these tubes to push aside muscle fibers.
The tube gives the surgeon a working channel through the muscles without cutting and stripping them away from the spine. The surgeon passes instruments through the tube to perform the fusion. A tiny TV camera on the end of the instruments allows the surgeon to view (on a computer screen) what's going on inside the spine.
There are many advantages to the minimally invasive techniques. Experts in favor of minimally invasive procedures say there is less soft-tissue trauma since the surgeon doesn't have to cut through all the layers of muscles and connective tissue.
For the same reason, there is less blood lost and less chance the patient will need a blood transfusion. The patient's pain is usually less and the hospital stay is often shorter. We hope you experienced all of these advantages with your procedure.