Two-levels mini-open transforaminal lumbar interbody fusion: technical note.

Objective: Mini-open transforaminal lumbar interbody fusion (oTLIF), previously described by Mummaneni et al., is a well-established technique that uses tubular dilators and retractors for treatment of single-level lumbar spinal stenosis.

Technique: We describe eight patients with two-level spinal stenosis who were operated on with minimally invasive spinal arthrodesis via a transforaminal route with the use of tubular retractors. This approach allowed us to obtain double-level cages insertion in all patients, with direct visualization of pedicular entry points and no screw malpositioning.

Conclusion: The oTLIF represents a good compromise in patients with two-level lumbar degenerative disease deserving surgery. Compared to standard open TLIF, it is associated with less postoperative muscular trauma, and faster recovery. This seems to be more evident in that category of patients in whom open approaches need longer incisions and more muscular fiber splitting. Compared to percutaneous TLIF (pTLIF), it allows for bilateral root decompression in every case. Bilateral cage insertion was also possible with this technique.