Transfacet minimally invasive transforaminal lumbar interbody fusion with an expandable interbody device—part II: Consecutive case series

Jawad M. Khalifeh, Christopher F. Dibble, Priscilla Stecher, Ian Dorward, Ammar H. Hawasli, Wilson Z. Ray

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


BACKGROUND: Advances in operative techniques and instrumentation technology have evolved to maximize patient outcomes following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). The transfacet MIS-TLIF is a modified approach to the standard MIS-TLIF that leverages a bony working corridor to access the disc space for discectomy and interbody device placement. OBJECTIVE: To evaluate clinical and radiographic results following transfacet MIS-TLIF using an expandable interbody device. METHODS: We performed a retrospective review of consecutive patients who underwent transfacet MIS-TLIF for degenerative lumbar spondylolisthesis. Patient-reported outcome measures for pain and disability were assessed. Sagittal lumbar segmental parameters and regional lumbopelvic parameters were assessed on upright lateral radiographs obtained preoperatively and during follow-up. RESULTS: A total of 68 patients (61.8% male) underwent transfacet MIS-TLIF at 74 levels. The mean age was 63.4 yr and the mean follow-up 15.2 mo. Patients experienced significant short- and long-term postoperative improvements on the numeric rating scale for low back pain (–2.3/10) and Oswestry Disability Index (−12.0/50). Transfacet MIS-TLIF was associated with an immediate and sustained reduction of spondylolisthesis, and an increase in index-level disc height (+0.71 cm), foraminal height (+0.28 cm), and segmental lordosis (+6.83). Patients with preoperative hypolordosis (<40) experienced significant increases in segmental (+9.10) and overall lumbar lordosis (+8.65). Pelvic parameters were not significantly changed, regardless of preoperative alignment. Device subsidence was observed in 6/74 (8.1%) levels, and fusion in 50/53 (94.3%) levels after 12 mo. CONCLUSION: Transfacet MIS-TLIF was associated with clinical improvements and restoration of radiographic sagittal segmental parameters. Regional alignment correction was observed among patients with hypolordosis at baseline.

Original languageEnglish
Pages (from-to)518-529
Number of pages12
JournalOperative Neurosurgery
Issue number5
StatePublished - Nov 1 2020


  • Expandable interbody device
  • Indirect decompression
  • Minimally invasive lumbar fusion
  • Spondylolisthesis
  • Transfacet MIS-TLIF


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