Novel Mini-open Transforaminal Lumbar Interbody Fusion

[Narrator] The investigation focuses on how MOTLIF, a novel minimally invasive technique provides enhanced clinical outcomes and improved radiological results in the treatment of lumbar degenerative disease when compared to traditional surgical methods. Lumbar decompression surgery is moving toward less invasive methods and quicker recovery after the operation, which makes the whole treatment process better for patients. MOTLIF combines the advantages of open and minimally invasive methods providing a customary alternative for grassroots surgeons because of its smooth learning curve. To begin, disinfect the surgical site on a patient under anesthesia, make a three centimeter longitudinal incision along the marked line on the lower back using a number 10 blade. Cut through the skin, subcutaneous tissue, and thoracolumbar fascia sequentially using a high frequency electrotome. Detach the paraspinal muscles along the spinous process using a high frequency electrotome to expose the affected spinous process, lamina, and part of the facet joint. Place the lamina retractor at the outer edge of the upper facet of the lower vertebra to expose the surgical field and establish the approach channel within five minutes. With an ultrasonic or ordinary bone knife, remove the superior subarticular process and part of the inferior super spinous process. Remove part of the ventral ligamentum flavum to expose the dura mater and nerve roots while preserving the dorsal ligamentum flavum and epidural fat. Remove the base of the spinous process and resect the hypertrophic ligamentum flavum until reaching the contralateral lateral recess to achieve a 270 degree decompression. Use a nerve root retractor to retract the nerve roots and dural sac and expose the operating area. Incise the annulus fibrosis using a number 11 scalpel. Then remove the nucleus pulposus with a Kerrison and scrape the end plate cartilage using a bone rongeur to expose the bony end plate. Sequentially dilate the intervertebral space with an intervertebral disc chisel and flush with normal saline to achieve hemostasis. Use a bone rongeur to trim the excised articular processes and part of the lamina and create approximately two square millimeter bone fragments. Pack some bone grafts into the cage. After placing the remaining fragments into the intervertebral space, position the cage centrally within the intervertebral space. After confirming the position of the intervertebral fusion device, use a neural stripper to probe the dural sac and nerve roots to confirm mobility, no compression, and absence of spinal canal stenosis. Now flush the intervertebral space with saline solution. Use three zero absorbable sutures to close the fascia layer with a locking technique. Perform continuous suturing of the fat layer and close the skin using either staples or sutures. Next, make a one centimeter incision at the projection sites of the pedicels above and below the target intervertebral space. Under C-arm fluoroscopy insert a sharp trocar needle through the skin to access the pedicle, ensuring precise positioning at the planned entry point. After confirming correct needle placement, use a small diameter reamer to gradually enlarge the particular channel. Using a dedicated guiding system, insert the pedicle screw and connecting rods, then tighten the screw caps, irrigate the incision with saline to ensure complete hemostasis. Use three zero absorbable sutures to close the incision layer by layer. Cover the incision with addressing and check postoperative lower limb activity. The mean operation time was significantly longer for multi-level surgeries compared to single level surgeries. Intraoperative blood loss was higher in multi-level procedures at 108.3 milliliters than in single level procedures, which was 62.5 milliliters. Postoperative cross-sectional area values of the paraspinal muscles showed no significant difference between the decompression and contralateral sides. Fat infiltration levels remained stable postoperatively showing no significant difference on either decompression or contralateral sides. MOTLIF procedure demonstrated minimal paraspinal muscle damage postoperatively with the cross-sectional area and fat infiltration remaining largely unchanged.