Modified minimally invasive transforaminal microscope-assisted fusion to treat lumbar foraminal stenosis combined with severe lumbar degenerative diseases.

Purpose: Lumbar foraminal stenosis combined with severe lumbar degenerative disease causing instability, radiculopathy and claudication may require surgery. The surgical treatment goals are decompression, restoration of the height of the disc and foramina and stabilize the spine. We used a modified minimally invasive transforaminal lumbar interbody fusion (TLIF) approach in those patients and evaluated its clinical efficacy.

Methods: We inserted the pedicle screws using the Wiltse approach and placed a tube retractor on the facet joint. The facet joint was partially removed to expose the spinal canal and foramina. The nerve roots were carefully decompressed under a microscope, and TLIF was performed using a large cage. Preoperative, postoperative, and last follow-up radiographic findings were evaluated, and the visual analogue scale scores were recorded.

Results: Twenty-five patients with foraminal stenosis underwent modified TLIF, with operation times ranging from 60 to 85 minutes and blood loss under 150 ml. Postoperative symptoms improved significantly, and no complications were observed during the 6 to 27-month follow-up. All patients returned to work, with well-restored disc and foraminal height on both sides and substantial improvements in visual analogue scale scores postoperatively and at the final follow-up.

Conclusion: This innovative technique represents a significant advancement in surgical practice by combining minimally invasive approaches with natural access to the lumbar foraminal region in fusion surgery. It offers several advantages, including cosmetic benefits, convenient access to the foraminal area, the ability to address multiple causes of foraminal stenosis, faster recovery, and ease of adoption for spine surgeons.