Corresponding Author

Khaled Omran

Authors ORCID


Subject Area

Minimally invasive procedures

Document Type

Original Study


Background Data: Minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) is less invasive with less blood loss, postoperative pain, comorbidities, and shorter hospital stays than traditional open surgery.

Purpose: This study aims to assess the feasibility of microscopic MIS-TLIF using a 50 ml plastic tubular syringe instead of expensive expandable or tubular retractors in the treatment of adult lumbar disc diseases, analyze the clinical, radiological, and functional outcomes, and compare our data with the recent studies discussing the same issue.

Study Design: Retrospective clinical study.

Patients and Methods: From 2018 to 2020, 35 patients with symptomatic lumbar disc diseases were treated by microscopic-assisted MIS-TLIF surgery through the Wiltse approach using a fashioned 50 ml plastic syringe. Back or leg pain was evaluated clinically using the visual analog scale (VAS), Oswestry disability index (ODI), and modified Prolo scales. Radiological workup included plain radiographs and magnetic resonance imaging (MRI). Perioperative data, incision length, and radiation time were documented. All patients were serially followed up regarding clinical, functional, and radiological outcomes. Interbody fusion was evaluated using Brantigan–Steffee–Fraser (BSF) criteria.

Results: A significant postoperative improvement in VAS for LBP and LL pain, ODI, and modified Prolo scores with statistically significant difference between preoperative, during, and at the final follow-up. The mean fusion time was 8.72±2.18 months, and according to BSF criteria, twenty-seven patients (90%) showed definitive fusion (grade 5). One patient had a temporary neurological deficit, one experienced a misplaced pedicular screw, and one had a surgical site infection.

Conclusion: Microscopic MIS-TLIF surgery using a novel plastic syringe is an effective, cheap procedure for treating symptomatic degenerative lumbar disc diseases with adequate canal decompression, radiological correction, and functional improvement without financial burden.


Minimal Invasive Surgery, Techniques, Transforaminal Lumbar Interbody Fusion, Lumbar Disc Diseases