Medical Student Duke University School of Medicine Durham, NC, US
Introduction: Transforaminal lumbar interbody fusion (TLIF) has evolved significantly since its inception, driven by the need for minimally invasive and effective solutions for lumbar spine pathologies. This presentation explores the historical evolution of TLIF and examines contemporary innovations, such as the integration of robotics, patient-specific surgery, and awake anesthesia, that aim to enhance surgical precision and patient outcomes.
Methods: A comprehensive review of literature on the development of the TLIF and its technical modifications, including minimally invasive TLIF (MIS TLIF), trans-Kambin TLIF, and transfacet TLIF, as well as recent studies on the use of nerve segmentation, robotics, and patient-specific implants was conducted.
Results: Originally developed to address degenerative disease and spinal instability, TLIF has seen innovative adaptations over the years, including MIS TLIF, trans-Kambin TLIF, and transfacet TLIF, leading to reduced operative trauma and improved postoperative recovery. MIS TLIF offers decreased muscle disruption and faster recovery compared to open TLIF, while trans-Kambin and transfacet approaches allow for further reduced invasiveness. In the last decade, robotics have increased intraoperative precision in hardware placement and alignment, while maintaining the surgical footprint of a minimally invasive approach. Recently, the integration of nerve segmentation for spine surgery has transformed preoperative planning as you can map vertebral, musculature, and neurovascular structures, see any existing aberrancies in anatomy, and plan for the optimal pedicle screw trajectory suited to individual patient anatomy. Furthermore, as three-dimensional printing becomes more widespread, the option of designing implants that are specific to an individual patient has become within reach.
Conclusion : The history of TLIF reflects a trajectory toward more refined and patient-centered approaches. New technologies and procedural modifications have transformed TLIF into a highly customizable and less invasive technique. The integration of robotics, patient-specific surgery, and awake anesthesia presents a promising future for TLIF, aligning with the goals of precision and personalization in spinal surgery. Future research and clinical trials are warranted to establish standardized protocols and determine long-term outcomes for these innovations in TLIF.
.jpg)
