Lower back pain can make it difficult to walk, sleep, or perform daily tasks. A person might experience back pain due to a number of conditions, such as aging, injury, or an underlying disease. Compression of the lumbar spine is one of many reasons a person might experience chronic back pain.

Compression of the lumbar spine typically occurs due to degeneration of the spine, resulting in misaligned vertebrae, pinched nerves, and other spinal abnormalities. Symptoms often include chronic pain in the lower back and/or legs, numbness, and paresthesia (“pins and needles”).

In many cases, non-surgical treatment can help improve these symptoms. However, if non-surgical treatment options don’t provide the desired relief, there are several minimally invasive surgical procedures to help achieve decompression of the lumbar spine and provide long-lasting relief from lower back pain.

Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery (MIS-TLIF)

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a common surgical procedure used to achieve decompression of the lumbar spine. Compared to open TLIF procedures, MIS-TLIF typically results in less blood loss, less tissue damage, less muscle dissection, less postoperative pain, and a shorter recovery time.


During an MIS-TLIF procedure, the surgeon will create small incisions on the lower back. This technique makes it easy to access the spine from an angle. Then, the surgeon will remove a portion of the spinal disc in order to decompress the problem area. The surgeon may also use a graft (also called a cage) to create space between the vertebrae, securing them with screws or rods. The average operating time is three hours.

Conditions and Symptoms MIS-TLIF Treats

Surgeons use TLIF to treat several spinal conditions and symptoms, including:

  • Lower back pain due to lumbar radiculopathy/sciatica
  • Spondylosis
  • Spinal stenosis
  • Degenerative disc disease
  • Recurrent disc herniation
  • Spinal instability (spondylolisthesis)
  • Pseudarthrosis


The average recovery time for a patient after MIS-TLIF is six weeks, although timelines can vary. Patients are often up and walking within hours after surgery, and most can return to driving and working after just two weeks. Patients can expect some mild back soreness for up to a month. Their doctor may prescribe pain medication and/or physical therapy to reduce pain and strengthen back muscles.

Minimally Invasive (MIS) Microdiscectomy

Traditionally, open microdiscectomy was the standard surgical treatment for lumbosacral disc herniation. However, modern advancements in surgical techniques and technology have popularized minimally invasive microdiscectomy (MIS microdiscectomy) as an alternative. Similar to MIS-TLIF, MIS microdiscectomy typically results in less tissue and muscle damage, less blood loss, reduced postoperative pain, and faster recovery.


During the procedure, the surgeon works through small incisions on the back to remove the disc herniation. The surgeon will remove only the herniated portion of the disc pushing on the nerve. This additional space will free the compressed nerve and provide relief.

Surgeons use one of several methods to perform MIS microdiscectomy:

  • Midline Microdiscectomy: The surgeon makes a one to two inch incision along the patient’s midline, using a retractor to separate the layers of tissue during the procedure.
  • Endoscopic Microdiscectomy / Microendoscopic Discectomy: The surgeon makes a much smaller incision and uses a miniature camera and other instruments to assist in the operation, causing even less tissue disruption.
  • Tubular Microdiscectomy: The surgeon makes a small incision off the midline, using small tubes or dilators to create a tunnel through the muscles and to the bone for operation.

This is a very quick operation, typically lasting between 30 to 60 minutes. In most cases, patients go home the same day.

Other Minimally Invasive Procedures

MIS-TLIF and MIS microdiscectomy are just two of several minimally invasive procedures your surgeon might recommend for your condition. Other options your surgeon might recommend could include:

  • Lateral lumbar interbody fusion (LLIF)/extreme lateral interbody fusion (XLIF®): The surgeon accesses and operates on the spine from the side/flank, often using grafts (cages) to separate the vertebrae.
LLIF - Read Patient Story
  • Oblique lateral interbody fusion (OLIF) is a minimally invasive surgical technique that minimizes cutting to muscles and uses a single port to access the disc space.
  • Posterolateral intertransverse onlay fusion: Using bone grafts, the surgeon fuses together misaligned or damaged vertebrae so they heal as one solid bone.
  • Percutaneous pedicle fixation: The surgeon places metal rods and screws to stabilize the spine.
Which Minimally Invasive Spinal Procedure Is Right for Me?

At Nkrumah Neurosurgery & Spine, we know that every patient and situation is unique. During your first visit to our practice, Dr. Nkrumah will sit down with you to discuss your symptoms, lifestyle, and goals. Then, you’ll go over treatment options, both surgical and non-surgical. Together, you will develop a plan to help you achieve the maximum amount of relief.

Schedule a consultation with Dr. Nkrumah by calling (631) 525-1420 or filling out this simple online form.

Midline Discectomy vs Endoscopic Discectomy

Conditions and Symptoms Microdiscectomy Treats

Surgeons typically use MIS microdiscectomy to treat a herniated disc compressing a spinal nerve. Doctors commonly recommend MIS microdiscectomy for young patients with only one level of disc herniation.

Symptoms of a herniated disc might include the following:

  • Back pain, which may extend down arms and/or legs
  • Muscle weakness
  • Difficulty with repetitive movements


The total recovery time after an MIS microdiscectomy procedure is typically six weeks or less. Most patients return home the same day as the procedure and can begin driving and performing low impact activities after just two weeks.

Patients might experience mild soreness and stiffness for several weeks and should avoid sitting or standing in the same position for more than 30 minutes. Other precautions include “no BLT” — no excessive bending, lifting or twisting. Doctors might recommend physical therapy to strengthen core muscles and loosen stiff joints, along with pain medication, often over-the-counter.

* XLIF is a registered trademark of NuVasive, Inc., San Diego, CA
Disc Herniation before surgery
Pressure relieved after Minimally Invasive Surgery
Minimally Invasive Spine Surgery