Surgeon Daniel Kim, MD, left, uses single position MIS fusion to save time in the operating room.

A procedure for relief of severe back and leg pain is improving outcomes for patients. A minimally invasive surgical (MIS) procedure called Transforaminal Lumbar Interbody Fusion (MIS TLIF) relieves pain caused by disc degeneration, spinal stenosis, and spinal instability.

Daniel Kim, MD and his colleagues at Southlake Orthopedic Spine Center at Grandview Medical Center are using some of the latest technologies to provide evidence-based best care for their patients. “My goal is to provide national standard spine care in Birmingham. We already have good spine care, but newer technologies can elevate the existing programs,” Kim says.

The MIS TLIF procedure is generally used to treat sciatica and back pain, most commonly caused by degenerative disc disease and subsequent pressure on the lumbar nerves. It is also an adaptation of a posterior lumbar interbody fusion used to stabilize the spine by restoring disc height and fusing the vertebrae together to alleviate nerve compression, eliminate instability, and maintain spinal balance.

Common indications for TLIF include severe foraminal stenosis requiring facet joint removal and recurrent disc herniation, asymmetric collapse, among others. “The concept of minimally invasive is to be normal anatomy sparing. It doesn’t necessarily have to do with the size of the incision, but it is the least trauma to the ligaments, muscles and joints, everything that controls the spine,” Kim says. “At the same time, it ensures that the goals for the surgery will be the same as an open surgery procedure.”

Kim performs the MIS TLIF procedure with robot assistance. “Formerly, TLIF was performed with a big midline incision and often we would have to peel the muscles off of the midline,” he says. “This new procedure helps with healing and preserving stability by maintaining natural anatomy while freeing up the nerves. I am able to work through a small tube that allows for sparing muscles and ligaments with the same decompression and interbody insertion. We approach from the patient’s back so we can clean out the disc space. We then place an interbody pacer, which supplies decompression and bone healing.”

As part of his MIS portfolio, Kim also performs cervical disc arthroplasty, minimally invasive posterior cervical decompression, MIS lumbar decompression, as well as robot assisted single-position lateral interbody fusion.

The single-position MIS fusion saves time in the operating room. “Patients are not under anesthesia as long, and it saves them from being in a prone position for a longer time,” Kim says. “I can better ensure the safety of the procedure for these patients. However, not everyone is a candidate for these minimally invasive procedures.”

In addition to the MIS TLIF and other minimally invasive methods, Kim plans to introduce endoscopic spine surgery for decompression procedures, surgeries that are commonly performed in Asia and Europe.

“In many places, the endoscopic procedure is standard-of-care for a certain disc herniation, because you use a sub-centimeter incision with minimal muscle or bone damage,” he says. “The cannula is the size of a ballpoint pen, and you can remove disc herniations using an endoscopic camera through which you can visualize nerves and structures. There is a steep learning curve, but this technology can be advantageous for our patients in the right setting.”

“Each of the procedures reduces blood loss and hospital stays. Naysayers may argue that at one year, most studies on any of these techniques have general equivalence. They often do, but I think the early outcomes matter as well. People want to feel good at their six-week visit, and I think that being mindful about the collateral damage during surgery helps.”

Kim is grateful for the guidance of the group of surgeons at Southlake Orthopedic Spine Center as well as his fellowship training at the Twin Cities Spine Center. “I am a product of my training, and I am lucky to be here, where I can continue to learn from these surgeons. They believe in ‘conservative management first,’ and take the holistic patient into consideration,” he says. “My philosophy is that we must preserve what God gave us as much as possible, but always make sure you achieve your surgical goals.”