Minimally invasive transforaminal lumbar interbody fusion for scoliosis: surgical technique for focal treatment of the lumbosacral fractional curve

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) can be utilized in the treatment of both adult spinal deformity and lumbar degenerative disease. This video focuses on the surgical technique and outcomes of MIS-TLIF aimed at correcting the symptomatic lumbosacral fractional curve, a key driver of pain and disability in scoliosis patients. Our patient is a 72-year-old male with scoliosis, who presented with 6 months of lower back pain radiating to the right distal lower extremity. His pain persisted despite physical therapy, medications, and injections. His symptoms significantly affected his daily activities. Preoperative imaging revealed a 10-degree fractional curve with an associated right-sided concavity, which resulted in impingement of the L4 nerve root in the right L3-4 lateral recess and the right L4-5 foramen. An L4-5 right-sided MIS-TLIF, right-sided L3-4 hemilaminotomy with medial facetectomy, and L3-5 posterior instrumented fusion was offered (L5-S1 was already autofused), and the patient consented to the procedure. The MIS-TLIF involved inferior and superior facetectomies, discectomy, and insertion of an expandable banana-style interbody cage at L4-5. An L3-4 hemilaminotomy with medial facetectomy was performed to decompress the right L4 traversing nerve root, and minimally invasive arthrodesis was achieved through direct facet decortication and packing with autograft and bone morphogenetic protein. Postoperative full-length plain radiographs demonstrated a reduction of the fractional curve to 1 degree. At 1-month follow-up, the patient reported complete resolution of his radicular pain and weakness. Twelve months later, he remained symptom-free and had returned to baseline activities. With a targeted approach to correct the fractional curve, MIS-TLIF can effectively treat symptoms in scoliosis patients. Consent was obtained from the patient for this surgical video.