Minimally Invasive Lumbar Fusion (MIS TLIF)
When the spine is unstable — most often from spondylolisthesis — decompression alone is not enough, and a fusion joins the unstable vertebrae so they heal into one solid segment. Minimally invasive TLIF achieves this through two small incisions instead of a long midline opening: the disc is removed and replaced with a spacer packed with bone graft, and screws are placed through the skin with navigation or robotic guidance.
Compared to open fusion, MIS TLIF dramatically reduces muscle damage and blood loss, and most patients go home in one to two days.
Who it is for
- Spondylolisthesis with nerve compression
- Recurrent disc herniation at the same level
- Instability after previous surgery
- Severe degenerative disc disease at one or two levels causing mechanical back pain that has failed non-surgical care
- Foraminal stenosis requiring disc height restoration
Why we use it
- Two small incisions; muscle-sparing
- Less blood loss and transfusion risk
- Shorter hospital stay (typically 1–2 nights)
- Accurate screw placement with navigation/robotics
- High fusion rates with modern implants and biologics
How the procedure is done
- General anesthesia, prone positioning, intraoperative navigation or robotic registration.
- Two paramedian incisions of 2–3 cm each.
- Through a tubular retractor, the facet joint is removed to reach the disc and decompress the nerve.
- The disc is removed; an interbody spacer with bone graft restores height and alignment.
- Pedicle screws and rods are placed percutaneously with real-time guidance and confirmed on imaging.
- Incisions are closed with absorbable sutures.
Recovery
Walking the same day. Home in 1–2 days. No bending, lifting over 10–15 lb or twisting for six weeks. Return to desk work at 2–4 weeks; physical therapy begins around six weeks; fusion consolidates over 3–6 months. No nicotine and no NSAIDs during fusion healing.
Risks, stated plainly
Infection, spinal fluid leak, nerve injury, hardware problems, non-union (higher in smokers), adjacent-level degeneration over years. Dr. Daggubati reviews the specific risks for your situation in person before any decision is made.
Preparing for this surgery
Dr. Daggubati has written detailed guides for this procedure covering medications to stop, prehabilitation, the day of surgery, and a week-by-week recovery timeline.
Common questions
Do I really need a fusion?
Dr. Daggubati is conservative with fusion. It is recommended only when there is clear instability or when decompression alone would predictably fail. If your imaging shows a stable spine, a decompression alone is usually the right answer.
How long until the fusion is solid?
Bone heals over 3–6 months, with continued maturation to 12 months. X-rays or CT at follow-up track progress.