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Minimally invasive lumbar fusion

Minimally invasive lumbar fusion (MIS) is a technique used to fuse one or more lumbar segments through small skin incisions, using percutaneous pedicular screws guided by fluoroscopy or intraoperative navigation. It is a useful option for grade I–II spondylolisthesis, degenerative instability or lumbar stenosis with instability, when pain or neurological symptoms have not improved with conservative treatment. Compared with classic open surgery, the MIS approach aims to preserve the paraspinal muscles, reduce blood loss and shorten recovery, while keeping the same surgical goals: decompression and stabilisation.

Spine neurosurgeon in Alicante and Benidorm
More than 20 years of experience in Neurosurgery (since 2003)
Vithas Medimar Hospital Alicante and Hospital Clínica Benidorm
Illustration of minimally invasive lumbar fusion showing percutaneous pedicular screws and rods placed through small skin incisions.

What is minimally invasive lumbar fusion?

Minimally invasive lumbar fusion (MIS) is a procedure to fuse one or more lumbar segments through small skin incisions. The pedicular screws are placed percutaneously, guided by fluoroscopy or intraoperative navigation, and connected with rods to stabilise the segment while the bony fusion takes place.

Unlike the traditional open approach, the paraspinal muscles are not stripped from the spine. This results in less blood loss, less postoperative pain and a faster return to daily activities. The technique is often combined with an interbody approach such as TLIF when nerve root decompression or restoration of disc height is also needed.

Not every patient is a candidate for MIS: the indication depends on the anatomy, the number of levels and the underlying pathology. To discuss your case, you can request an assessment with Dr. Ben Ghezala.

Symptoms and warning signs

Patients who may benefit from MIS lumbar fusion typically report:

Mechanical low back pain that worsens with standing or walking
Pain radiating to one or both legs (sciatica), with or without tingling
A sensation of instability or that the back gives way with certain movements
Neurogenic claudication: heavy or tired legs after a short walking distance
Warning signs: progressive leg weakness, bowel or bladder changes or saddle anaesthesia

When is this procedure indicated?

Degenerative or isthmic spondylolisthesis grade I–II with pain or radiculopathy
Lumbar stenosis with documented instability on dynamic X-rays
Degenerative disc disease with disabling mechanical pain at one or two levels
Recurrent disc herniation with instability after previous surgery
Segmental low back pain that has not improved after months of conservative treatment or injections

How is the procedure performed?

1.Preoperative preparation

Includes a detailed clinical assessment, MRI and dynamic X-ray review and planning of each screw trajectory on the imaging. Fasting instructions, medication adjustments (especially antiplatelets and anticoagulants) and case-specific recommendations are provided.

2.During the procedure

With the patient in the prone position under general anaesthesia, the pedicles are located with fluoroscopy or navigation. Through small incisions of about 1.5–2 cm on each side, needles and dilators are advanced to the pedicle and the percutaneous screws are placed. When indicated, a decompression or interbody approach (TLIF) is performed through one of the incisions to remove the disc and place a cage. Finally, the rods are passed through the screws and tightened to stabilise the segment.

3.Immediate postoperative period

After surgery, patients spend a short time in the recovery unit before returning to their room. Walking with support usually begins the same day or the next morning. Pain from the small incisions is generally well controlled, and the typical hospital stay is 2–3 nights depending on the case and number of levels treated.

Recovery after minimally invasive lumbar fusion

Recovery is gradual but generally faster than after open fusion. Light daily activities can usually be resumed within 1–2 weeks. Return to office work typically occurs between 3 and 6 weeks; physically demanding jobs require 2–4 months depending on the case.

Bony fusion takes several months to consolidate and is supported by a progressive rehabilitation programme: daily walking, core strengthening and gradual return to activity. The skin scars are small and discreet, which also helps the postoperative period.

Fever, worsening pain, wound drainage, new weakness or bowel/bladder changes warrant prompt medical review.

Risks and possible complications

Any surgery carries general risks such as infection, bleeding, deep vein thrombosis or anaesthesia-related issues. In MIS lumbar fusion, less muscle trauma usually means lower blood loss and lower wound infection rates than with an open approach.

Specific risks include screw misplacement, injury to a nerve root or dura (CSF leak), pseudarthrosis or non-union of the fusion, hardware loosening or breakage, and accelerated degeneration of adjacent levels over time. Intraoperative radiation from fluoroscopy is another factor and is minimised with careful technique or with navigation.

Frequently asked questions

MIS lumbar fusion typically lasts between 2 and 4 hours, depending on the number of levels treated and whether an interbody approach such as TLIF is added. A short recovery period follows before returning to the hospital room.
No. The MIS technique uses several incisions of about 1.5–2 cm for the screws and, if needed, a slightly larger incision for the interbody approach. After a few months the scars usually become small and discreet.
Postoperative pain after MIS fusion is usually clearly lower than after an open approach because the paraspinal muscles are not stripped from the spine. A stepwise analgesia protocol is used and most patients are able to walk the next day.
Most patients return to office work within 3–6 weeks. Physically demanding or heavy-lifting jobs may require 2–4 months, adjusting the return to radiological fusion progress and clinical tolerance.
Walking is reintroduced from the beginning. Stationary cycling, swimming and gentle mobility usually restart from 6–8 weeks. Impact sports, heavy lifting or contact sports are reintroduced gradually several months later, depending on fusion progress and specialist advice.
The surgical goals are the same: decompression and fusion. The difference lies in the approach: MIS is performed through small incisions without stripping the paraspinal muscles, which translates into less blood loss, less postoperative pain and a faster recovery. Not every patient is a candidate for MIS, and the indication is assessed individually.

Other related treatments

Anterior lumbar interbody fusion (ALIF) illustration showing the interbody cage at L5-S1 via an anterior retroperitoneal approach.

ALIF — Anterior lumbar interbody fusion

Lumbar fusion performed through the abdomen, in collaboration with a vascular surgeon, allowing indirect decompression, restoration of disc height and lordosis and segmental stabilisation, particularly at L5-S1.

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Illustration of lumbar lateral recess decompression with microsurgical undercutting, freeing the nerve root while preserving the facet joint.

Lateral recess decompression

Lumbar microsurgery that frees the entrapped nerve root in the lateral recess while preserving the facet joint, relieving radicular pain and neurogenic claudication.

View treatment
Endoscopic lumbar discectomy illustration: transforaminal endoscope removing an L5-S1 disc herniation through a 7 mm incision.

Endoscopic lumbar discectomy

Minimally invasive surgery that removes a lumbar disc herniation through a 7-8 mm incision with an endoscope, under local anaesthesia or sedation, with same-day discharge.

View treatment

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Do these symptoms sound familiar?

If you recognise yourself in some of these symptoms and your pain is starting to limit your daily life, we can review your case in a personalised consultation. Dr. Ben Ghezala will assess your clinical history and imaging studies to help you decide the best treatment option for you.

Request a consultation with Dr. Ben Ghezala