Minimally Invasive Spine Fusion

During a minimally invasive spinal fusion, Dr. Lauren Boden makes one or more small incisions instead of a large open incision. Using fluoroscopy (X-ray), CT navigation, and/or robotic guidance, she is able to accomplish deformity correction, place interbody cages as needed, and obtain spinal fusion using special instruments while minimizing soft tissue dissection. The implanted hardware promotes bone fusion and over time the vertebrae fuse to form a solid bone structure, stabilizing the spine and reducing pain. The entire procedure is performed with minimal disruption to surrounding tissues, which significantly reduces recovery time and postoperative pain. Minimally invasive spine fusions include:

Percutaneous posterior spine fusion

Screws and rods are placed through small incisions on the back. This stabilizes the spine and is often used to stabilize fractures or in combination with the other minimally invasive interbody fusions described below.

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF)

Small incisions are made in the lumbar spine and then one facet joint is removed and a small interbody cage is inserted, then screws and rods are placed. This is typically used to treat conditions with radicular pain affecting a single nerve root that require direct decompression and fusion.

Extreme lateral interbody fusion (XLIF)

The patient is positioned on their side (lateral) and then X-ray is used to mark out the appropriate level and disc space. A small incision is made on the side and then soft tissues are moved out of the way and a special retractor is used to protect the soft tissues. The intervertebral disc is removed and a large interbody cage is inserted to provide indirect decompression of the nerve roots at that level. This can be done in isolation with a plate and screws holding the cage in place or can be combined with posterior instrumentation. This is typically performed for conditions affecting a single level with bilateral symptoms.

Oblique lateral interbody fusion (OLIF)

The patient is positioned on their side (lateral) and a small incision is made on the side slightly anterior to the one used for XLIF. An approach surgeon is often used to assist with the exposure. Similar to an XLIF, the soft tissues are protected, the disc is removed, and a large interbody cage is inserted, providing indirect decompression of the nerve roots. The cage can be standalone, but is often combined with posterior instrumentation. This can be performed at multiple levels and can be used to correct deformity.

Anterior lumbar interbody fusion (ALIF)

An approach surgeon is used to make an incision in the front and move the soft tissues out of the way to expose the anterior spine. Once the approach surgeon has protected the nearby soft tissues, Dr. Boden removes the intervertebral disc and places a large interbody cage from the front. The cage is secured with screws. The approach surgeon then closes the incision with absorbable sutures. Posterior instrumentation is often used for additional support of the fusion. This is typically performed at the lower lumbar levels to indirectly decompresses the nerve roots, and can also help correct deformity.

Minimally invasive spinal fusion offers several advantages over traditional open spinal fusion. One of the most significant benefits is reduced trauma to muscles and soft tissues, which leads to less postoperative pain and faster recovery.

• Since the procedure requires smaller incisions, there is also a lower risk of infection and reduced blood loss during surgery. Patients often experience shorter hospital stays—sometimes as brief as one day compared to several days for open surgery.
• Additionally, the use of advanced imaging and navigation techniques enhances surgical precision. Many patients report quicker returns to daily activities and a reduced need for postoperative pain medication.

Minimally invasive spinal fusion is ideal for patients who require spinal stabilization due to degenerative conditions, instability, or deformities.

• Good candidates typically have persistent back or leg pain that has not responded to conservative treatments such as physical therapy, medication, or injections.
• Patients with conditions like degenerative disc disease, spondylolisthesis, spinal stenosis, degenerative scoliosis, or fractures that compromise spinal stability may benefit from these procedures.
• However, certain patients, such as those with severe spinal deformities, primary spine tumors, or osteoporosis, may require more traditional techniques. A thorough evaluation by a spine surgeon, like Dr. Lauren Boden, M.D., is necessary to determine the most appropriate treatment plan.

Recovery from minimally invasive spinal fusion is generally quicker and less painful than traditional open surgery. Most patients can walk within a few hours after surgery and are discharged from the hospital within a day or two. Pain management typically involves over-the-counter or mild prescription medications, and many patients experience significant relief from their preoperative symptoms within weeks.

Walking is a key component of the recovery process. Patients are usually advised to start gentle movements soon after surgery to prevent stiffness and promote healing. A structured rehabilitation program, including guided exercises to strengthen the core and back muscles, may be offered after the first six weeks as needed. While the bone fusion process takes several months to fully mature, most patients can return to light activities within a few weeks and resume normal daily activities within 6-12 weeks. Heavy lifting and high-impact activities should be avoided during the early recovery period to ensure proper fusion and prevent complications.