Intervertebral micro access surgery for transforaminal lumbar interbody fusion

Background: Minimally invasive spine surgery (MIS) has undergone tremendous progress in the past 2 decades. The intervertebral micro access surgery (iMAS) technique represents a hybrid of both open and minimally invasive techniques. OBJECTIVE: To describe the surgical technique and operative nuances of the iMAS technique. METHODS: We describe a novel operative approach for the standard transforaminal lumbar interbody fusion with pedicle screw fixation. Described are the preoperative planning, incision and approach, pedicle screw insertion, facetectomy and discectomy, transforaminal interbody placement, and direct decompression. RESULTS: Early experience suggests that iMAS is well suited for the same degenerative conditions currently treated with open or MIS transforaminal lumbar interbody fusion, including grade I spondylolisthesis, unilateral synovial cysts with instability, unilateral disc herniations with instability, and recurrent disc herniations. CONCLUSION: The novel integration of both open and MIS techniques makes iMAS an attractive approach for select degenerative lumbar disease processes. Similar to other MIS procedures, minimal tissue disruption may allow for more rapid patient recovery, reduced blood loss, and reduced length of hospital stay.