Minimally Invasive Instrumented Spondylolisthesis Surgery (Mini-TLIF)

Transcript translated from Turkish (video audio remains in Turkish)

Hello everyone, I am Dr. Mehmet Levent Deniz, a specialist in brain, nerve and spine surgery. I will explain the minimally invasive TLIF technique, also called closed spondylolisthesis surgery, that I use for vertebral slippage.

With advances in biomedical engineering and growing surgical experience in recent years, spondylolisthesis operations can now be performed using a minimally invasive approach. This operation, called minimally invasive TLIF or Mini-TLIF, is performed under general anaesthesia. A skin incision of approximately 3 centimetres is made. We pass between the fascia of two muscles without damaging the muscle tissue to reach the bone. After removing a very small amount of bone, the disc space is completely cleared. A cage called a TLIF cage and a bone graft are placed in the cleared space. Screws and connecting rods are then placed percutaneously, that is, in a closed manner, on both sides under imaging guidance.

The operation takes approximately two to two and a half hours. The hospital stay is two days.

Thanks to this technique, spondylolisthesis surgery has become an operation with almost no bleeding, only a 3-centimetre skin incision and almost no damage to muscle tissue.

I wish you all pain-free and happy days. Stay well.

What Is Minimally Invasive Instrumented Spondylolisthesis Surgery?

Minimally invasive instrumented spondylolisthesis surgery (Mini-TLIF) stabilises slipped vertebrae by placing screws and a cage through an approximately 3 cm incision without extensive muscle stripping. Like lumbar disc surgery, spondylolisthesis surgery can be performed using a percutaneous technique.

How Is Minimally Invasive Instrumented Spondylolisthesis Surgery Performed?

The operation is performed under general anaesthesia and imaging guidance in three stages: access, clearing the disc space and placing a cage, and percutaneous screw fixation.

• Access and Tissue Preservation: Entry is through an approximately 3 cm skin incision. Unlike the conventional open approach, muscles are not extensively stripped; bone is reached through the natural plane (fascia) between muscle fibres.
• Disc Removal and Cage Placement: After a very small amount of bone is removed, the disc material is cleared and the disc space prepared for fusion. A TLIF cage is placed in this space to maintain disc height, together with bone graft to enable the two vertebrae to unite.
• Percutaneous Screw Placement: Finally, the screws and rods that stabilise the spine are placed on both sides through small skin incisions under fluoroscopic guidance.

Recovery Time and Advantages

The operation takes an average of 2–2.5 hours; patients walk on the day of surgery and generally stay in hospital for one day.

• Recovery: Limited tissue damage means less early postoperative pain and earlier movement.

What Is the Success Rate of Minimally Invasive Instrumented Spondylolisthesis Surgery?

Minimally invasive instrumented spondylolisthesis surgery has a success rate as high as open surgery: fusion rates and the need for repeat surgery are the same [2]; long-term improvements in pain and daily functioning are also equal [2, 3]. Lower back pain and daily limitations were slightly lower with the minimally invasive method [4]. Hospital stay is approximately 2 days shorter [2].

What Are the Risks of Instrumented Spondylolisthesis Surgery (Mini-TLIF)?

Surgical-site infection is 1.2% (versus 4.6% with open surgery), and overall complications are 25% lower than with open surgery [2, 4]. Blood loss is also markedly reduced [2, 4]. However, fluoroscopic guidance means longer radiation exposure, and the technique requires more experience than open surgery [1, 3].

🩺 Physician’s Insight & Clinical Experience

“We see the greatest comfort that microsurgery and minimally invasive methods have brought to neurosurgery in spondylolisthesis operations. However, I can only use this operation in my patients with one-level or, at most, two-level slippage. In open operations, stripping muscles from bone used to cause prolonged postoperative lower back pain. With Mini-TLIF, we pass between the muscles instead. Because tissues remain in their original anatomy, our patients can walk along the corridor the same day, almost without feeling they have undergone surgery. Combining technology and experience markedly improves patient comfort.”

Frequently Asked Questions

What Is Minimally Invasive Instrumented Spondylolisthesis Surgery (Mini-TLIF), and How Is It Performed?

Mini-TLIF stabilises slipped vertebrae by placing screws and a cage percutaneously through an approximately 3 cm incision without stripping muscles.

What Is the Success Rate of Minimally Invasive Instrumented Spondylolisthesis Surgery?

The success rate is as high as with open surgery: fusion and reoperation rates are the same, as are long-term improvements in pain and daily functioning [2, 3].

Can Every Spondylolisthesis Be Operated on with Mini-TLIF?

No. The minimally invasive method is used for one-level or, at most, two-level slippage. Multilevel slips, advanced spinal curvature or dense adhesions from previous surgery require open surgery.

Does Minimally Invasive Instrumented Spondylolisthesis Surgery Have Risks or Side Effects?

Yes: surgical-site infection is 1.2% (versus 4.6% with open surgery), and blood loss is lower [1, 2, 4]. Conversely, fluoroscopy leads to longer radiation exposure, and the technique requires more experience [1, 3].

How Long Does Instrumented Spondylolisthesis Surgery Take?

The operation takes an average of 2–2.5 hours.

How Long Must I Stay in Hospital Afterwards?

Patients walk on the day of surgery; the hospital stay is generally one day.

When Can I Return to Work?

Patients can return to work approximately two weeks after surgery.

Will My Body Recognise the Screws as Foreign and Reject Them?

No, titanium screws are biocompatible; tissue rejection like that after an organ transplant does not occur. True metal sensitivity is very rare.

Will the Screws Prevent an MRI for Another Condition?

You can have an MRI: the titanium screws used are MRI-compatible. Image quality is only slightly affected in the region containing the screws.

What Material Are the Screws Made of?

Titanium alloy (titanium–aluminium–vanadium), a lightweight, durable and biocompatible material.

Can the Screws Bend, Break or Become Displaced?

Usually not. Once fusion has occurred, bone carries a substantial part of the load. Screw loosening is rare but may occur with excess weight, uncontrolled movements or delayed fusion related to smoking.

Do the Screws Have a Limited Lifespan or Need Replacing Later?

No, these screws have no expiry date. Once bone fusion is achieved, they can remain in the body for life and need not be removed unless they cause a problem.

Will the Implants Trigger Airport or Shopping-Centre Security Gates?

Titanium screws usually do not trigger conventional metal detectors, although implants may be detected by body scanners. If an alarm sounds, showing your operation report makes additional checks easier.

When Will My Sexual Life Return to Normal After Instrumented Spondylolisthesis Surgery?

Usually, patients gradually return to normal 4–6 weeks after surgery once tissue healing is complete.

How Long Must I Wear a Brace After Instrumented Spondylolisthesis Surgery?

I generally prescribe a brace for 4–6 weeks after surgery to support bone fusion. It is then gradually discontinued to strengthen the back muscles. Brace use may vary according to the surgeon’s preference.

Which Specialist Performs Minimally Invasive Instrumented Spondylolisthesis Surgery in Istanbul?

One of the physicians performing this operation in Istanbul is M. Levent Deniz, MD, a specialist in neurosurgery.

How Much Does Instrumented Spondylolisthesis Surgery Cost?

As treatment costs vary according to the patient and hospital conditions, a definite fee can only be determined after examination and review of imaging.

References

1. Jagtiani P, Karabacak M, Margetis K. Comparative Effectiveness of Open Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion: An Umbrella Review of Meta-Analyses. Clin Spine Surg. 2024. PMID: 38245811.
2. Patel S, Nischal SA, White GW, et al. Minimally invasive versus open transforaminal lumbar interbody fusion for low grade lumbar spondylolisthesis: a systematic review and meta-analysis. Spine Deform. 2026 Jul 20. PMID: 42477285.
3. Hammad A, Wirries A, Ardeshiri A, Nikiforov O, Geiger F. Open versus minimally invasive TLIF: literature review and meta-analysis. J Orthop Surg Res. 2019;14(1):229. PMID: 31331364.
4. Phan K, Rao PJ, Kam AC, Mobbs RJ. Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis. Eur Spine J. 2015;24(5):1017-1030. PMID: 25813010.

• 👨‍⚕️ Author and medical reviewer of this content: M. Levent Deniz, MD – Neurosurgery Specialist
• ⚠️ Medical Disclaimer: This page is for information only; consult your doctor for diagnosis and treatment.