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MIS-TLIF (Minimally Invasive Transforaminal Lumbar Interbody Fusion)

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Bringing Minimally Invasive Precision to Spine Surgery

MIS-TLIF (Minimally Invasive Transforaminal Lumbar Interbody Fusion)
MIS-TLIF (Minimally Invasive Transforaminal Lumbar Interbody Fusion)

One of the most prevalent health issues in the world is back pain, and individuals who experience no improvement from conservative measures may need surgery. Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) is a safe, efficient, and patient-friendly approach for treating several spinal problems among the cutting-edge surgical methods now accessible.

MIS-TLIF: What is it?

MIS-TLIF_ What is it
MIS-TLIF_ What is it

A specialised procedure called MIS-TLIF is used to stabilise the spine and relieve persistent leg or back discomfort brought on by recurrent disc herniations, spondylolisthesis, spinal stenosis, or degenerative disc degeneration. In order to minimise tissue disruption, MIS-TLIF is carried out through small incisions using tubular retractors and specialised equipment, as opposed to typical open spine surgery, which entails big incisions and considerable muscle dissection.

The surgeon uses a posterolateral (back and side) technique to gain access to the spine during the treatment. In order to encourage fusion between the vertebrae and restore spinal stability, the injured disc material is removed and an interbody cage or bone graft is inserted into the disc area.

Signals/ Indications for MIS-TLIF

Patients who suffer from the following symptoms may be eligible for MIS-TLIF:

Signals_ Indications for MIS-TLIF
Signals_ Indications for MIS-TLIF
  • Chronic sciatica (lower back or leg pain) that does not go away with non-surgical measures
  • Stunting of the back
  • Degenerative disc disease
  • Slipping of one vertebra over another is known as spondylolisthesis.
  • Spinal stenosis, or spinal canal narrowing
  • Frequent herniations of the disc

Before suggesting surgery, a comprehensive clinical evaluation, imaging tests such as MRI and CT scans, and a complete discussion of non-operative therapy options are necessary.

MIS-TLIF’s Benefits Over Standard Surgery

MIS-TLIF's Benefits Over Standard Surgery
MIS-TLIF’s Benefits Over Standard Surgery

MIS-TLIF’s minimally invasive design has the following advantages:

  • Smaller incisions: Improving cosmetic results and minimising scarring
  • Reduced blood loss: Reduced need for transfusions
  • Faster recuperation due to less injury to muscles and tissues
  • Hospital stays are typically shorter—1-2 days as opposed to 4-5 days for open surgery.
  • Quicker return to work and regular tasks
  • Reduced need for painkillers as a result of less postoperative discomfort

Furthermore, reducing tissue damage may lessen the chance of further neighbouring segment degeneration and preserve the spine’s original structure.

How is the process carried out?

  • Anaesthesia and Positioning: The patient lies face down on a specialised surgical table while under general anaesthesia.
  • Access to the Spine: Tubular retractors are placed through tiny incisions (about 1-2 cm) to gently stretch muscles apart instead of slicing through them.
  • Damaged Disc Removal: To reach the disc space, the surgeon performs a facetectomy, which involves removing a portion of the vertebra. The degenerated disc material is then extracted.
  • Graft/Cage Insertion: To promote fusion, a bone graft or cage loaded with bone graft material is placed into the disc space.
  • Stabilisation: To keep the vertebrae stable while they heal, screws and rods are inserted percutaneously.
  • Closure: After removing the instruments, surgical glue or sutures are used to seal the tiny incisions.

Recuperation and Rehabilitation

After surgery, the majority of patients start walking within a day. Strengthening the back and core muscles is facilitated by a customised physical therapy program. It usually takes 6 to 12 months for the vertebrae to fully fuse, during which time activity limitations (such as avoiding heavy lifting) could be advised.

Following to post-operative instructions, imaging studies, and routine follow-up visits are essential for a successful and seamless recovery.

Hazards/Risks and Things to Think About

MIS-TLIF has hazards, just like any other surgical surgery. These risks include:

  • Infection
  • Damage to the nerves
  • Nonunion (bones not fusing together)
  • Problems relating to hardware
  • Chronic discomfort

However, these risks are reduced and patient results are frequently great when carried out by a skilled neurosurgeon who specialises in minimally invasive procedures.

In conclusion

In comparison to traditional techniques, MIS-TLIF offers patients better spinal stability, quicker and less painful recovery, and effective pain treatment. It is a major improvement in spine surgery. Speaking with a spine specialist can help you decide if MIS-TLIF is the best course of action if you or a loved one has persistent leg or back discomfort.

Sources:

  1. https://www.globusmedical.com/wp-content/uploads/2019/04/Transforaminal-Lumbar-Interbody-Fusion-MIS-TLIF-Patient-Brochure.pdf
  2. https://pmc.ncbi.nlm.nih.gov/articles/PMC7263344/
  3. https://www.bangkokinternationalhospital.com/health-articles/disease-treatment/mis-tlif
  4. https://pubmed.ncbi.nlm.nih.gov/32528800/
Table of Contents

You May Also Know Related to Gamma Knife
FAQ’s

Gamma Knife uses 192–201 precisely focused beams of gamma rays that converge at a single target point in the brain. This high dose of radiation damages the DNA of abnormal cells, stopping their growth or causing them to shrink, while minimizing exposure to nearby healthy tissue.

No, Gamma Knife is not a traditional surgery. It is a non-invasive outpatient procedure performed without any incision, stitches, or general anesthesia in most cases.

Gamma Knife is commonly used for:

Brain tumors (benign and malignant)
Metastatic brain lesions
Arteriovenous malformations (AVMs)
Trigeminal neuralgia
Acoustic neuromas (vestibular schwannomas)
Pituitary tumors
Certain functional disorders (like tremors)

The procedure is generally painless. Patients may feel mild pressure while the head frame (if used) is applied or may experience slight discomfort from anesthesia injections, but the treatment itself is not painful.

Depending on the condition and treatment plan, Gamma Knife may take 30 minutes to 3 hours. Most patients go home the same day.

Common side effects are usually mild and temporary, including:

Headache
Nausea
Fatigue
Mild scalp swelling or tenderness at the frame site
Rarely, some patients may experience delayed radiation effects such as brain swelling or radiation necrosis.

Most patients can return to their normal routine within 24–48 hours after the procedure.
You may feel mild fatigue for a few days.
Follow-up imaging is usually required after 1 year.

Gamma Knife has a high success rate and has been used worldwide for decades. Its effectiveness depends on the condition treated, size and location of the lesion, and overall patient health. In many cases, it offers results comparable to open surgery with fewer risks.

Yes, in some cases Gamma Knife treatment can be repeated if the disease recurs or if new lesions develop.

Yes. Gamma Knife is considered one of the safest and most precise forms of radiosurgery, with millions of patients treated globally and extensive clinical data supporting its use.

Eligibility depends on factors such as:

Size and location of the lesion
Overall health and age
Whether open surgery is too risky
A neurosurgeon and radiation oncologist will decide if Gamma Knife is the best option for you.

A detailed MRI or CT scan is performed to map the brain.
A lightweight head frame or mask is used for accuracy.
Your doctors plan the radiation dose and target areas using specialized software.

Local anesthesia is given if a head frame is used.
General anesthesia is usually not required, except for children or patients unable to remain still.

Costs vary depending on hospital, city, and condition treated. On average, Gamma Knife in India ranges from ₹1.5 lakh to ₹4.5 lakh. It is usually more affordable compared to treatment in Western countries. At AIIMS Delhi, it is much more affordable around ₹75,000 which makes it affordable for the patients in need.

AIIMS Delhi is one of the leading centres for Gamma Knife in India.

AIIMS uses the latest Gamma Knife Perfexion system.

It has successfully treated thousands of patients for brain tumors, blood vessel problems, and even eye cancers.

The treatment is done by expert neurosurgeons such as Dr. Deepak Agrawal and team.

Clinic timings for Gamma Knife OPD at AIIMS Delhi: Monday & Friday, 8:00 AM – 9:00 AM.

Cost is around ₹75,000 and is subsidized compared to private hospitals.

The whole procedure is usually done in one day:

  • Consultation & Planning – Doctors review your scans and decide the treatment.
  • Head Frame/Mask – A lightweight frame or mask is placed to keep your head still.
  • Imaging – MRI/CT scans are done to locate the exact target.
  • Treatment Planning – Specialists plan the dose and direction of radiation.
  • Gamma Knife Treatment – You lie on the machine; painless radiation beams treat the target (30 mins–3 hrs).
  • Recovery & Discharge – The frame is removed, and most patients go home the same day.
  • Follow-up – MRI after a few months to check results.

Before you get a treatment date, you need to complete a few steps:

  • OPD Registration – Visit the Neurosurgery OPD (Gamma Knife clinic at AIIMS, Mon & Fri 8–9 AM) and register.
  • Consultation with Doctor – Meet the neurosurgeon who will check your reports, MRI/CT scans, and medical history.
  • Investigations – Sometimes fresh MRI/CT or blood tests are needed for treatment planning.
  • Medical Fitness – Basic checks like blood pressure, sugar, heart condition, etc.

Financial/Insurance Approval –

  1. If using Ayushman Bharat or government schemes, you need approval papers.
  2. If self-paying, you will be given the estimated cost (~₹75,000 at AIIMS).
  • Consent & Admission Slip – Once doctors confirm you are fit and formalities are done, you sign the consent form.
  • Treatment Date Allotment – A date is given for your Gamma Knife procedure.

Once you receive your Gamma Knife date, you’ll need to do a few simple things before the procedure:

  • Admission Process – Report to AIIMS on the morning of your procedure and complete admission at the Neurosurgery ward/Daycare.
  • Paperwork – Carry your OPD slip, MRI/CT films, blood test reports, admission slip, and ID proof. If you are covered under Ayushman Bharat/insurance, keep those approval papers ready.
  • Consent Forms – You (or a family member) will sign consent for the procedure and anesthesia.
  • Medical Check-up – Doctors will check your BP, sugar, heart rate, and do a quick physical exam.
  • Fasting – Usually, you will be asked to not eat or drink for 6 hours before the procedure.
  • Pre-Procedure Prep – An IV line may be put, and medicines (sedation/antibiotics if needed) are given.
  • Treatment – You are then taken to the Gamma Knife room for frame/mask placement, imaging, and treatment.

After the procedure, you’ll be observed for a few hours and most patients are discharged the same day or next morning.

Urea & creatinine

No, You can have light breakfast.

Yes, you can take the medicine and then come for the treatment.

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