[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-450921-105":59,"doc-detail-450921-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","ten-step-technique-for-navigated-tubular-transforaminal-and-extraforaminal-lumbar-interbody-fusion","Ten-step technique for navigated tubular transforaminal and extraforaminal lumbar interbody fusion","","Minimally invasive transforaminal lumbar interbody fusion (mTLIF) is used for degenerative lumbar spinal disorders refractory to nonoperative care, but its technical demands create surgeon variability and a steep learning curve. Based on extensive experience, the study provides a ten-step, technology-integrated workflow for total 3D navigated tubular mTLIF, and describes minimally invasive extraforaminal lumbar interbody fusion (mELIF) as an intertransverse alternative that reduces dural exposure and incidental tears. Retrospective review of 350 cases supported reproducible operative guidance with supplemental illustrations and videos, and compared outcomes across the mTLIF and mELIF cohorts.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/ten-step-technique-for-navigated-tubular-transforaminal-and-extraforaminal-lumbar-interbody-fusion/450921/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/ten-step-technique-for-navigated-tubular-transforaminal-and-extraforaminal-lumbar-interbody-fusion/450921.png","ImageObject",300,407,{"name":92,"@type":93},"นรินทร์","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-08","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",13,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the purpose of the ten-step workflow for navigated mTLIF and mELIF?","Question",{"text":113,"@type":114},"It provides standardized, detailed step-by-step surgical guidance to improve safety, efficiency, and reproducibility when performing total 3D navigated tubular mTLIF and mELIF.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How does mELIF differ from mTLIF in surgical approach?",{"text":118,"@type":114},"mELIF uses an extraforaminal, intertransverse corridor that avoids canal entry and limits dural manipulation, making it a particularly valuable option for revisions and significant foraminal pathology.",{"name":120,"@type":111,"acceptedAnswer":121},"What were the reported outcomes and complications across the 350 cases?",{"text":122,"@type":114},"Complications occurred exclusively in the mTLIF cohort (2.1%), including CSF leak, wound infection, and hardware complications, with no neurological complications reported; median hospital stay was shorter for mELIF (24 hours) than for mTLIF (48 hours).","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},450921,1791095587,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":36,"preview_page_count":4},2336475104957,"https://ap-avatar.wpscdn.com/avatar/22000c4c6bd8a5076e1?x-image-process=image/resize,m_fixed,w_180,h_180&k=1787554080175789136","Surgical Technique  \nTen-step technique for navigated tubular transforaminal and extraforaminal lumbar interbody fusion  \nAhmet Kartal1\\#^, Minaam Farooq1\\#, Mousa K. Hamad1, Rachel Bratescu1, Chibuikem A. Ikwuegbuenyi1, Noah Willett1, Blake I. Boadi1, Jessica Berger1, Alan Hernández-Hernández2,  \nPedro Leonardo Villanueva-Solórzano2, Roger Härtl1  \n1Department of Neurological Surgery, Och Spine at NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA; 2National Institute of Neurology and Neurosurgery, Mexico City, Mexico  \nContributions: (I) Conception and design: A Kartal, M Farooq, MK Hamad, R Härtl; (II) Administrative support: R Härtl; (III) Provision of study materials or patients: R Härtl; (IV) Collection and assembly of data: A Kartal, R Härtl; (V) Data analysis and interpretation: A Kartal, MK Hamad, N Willett, R Härtl; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.  \n\\#These authors contributed equally to this work.  \nCorrespondence to: Roger Härtl, MD. Department of Neurological Surgery, Och Spine at NewYork-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 99, New York, NY 10065, USA. Email: [roh9005@med.cornell.edu](roh9005@med.cornell.edu).  \nAbstract: Minimally invasive transforaminal lumbar interbody fusion (mTLIF) is an effective technique for treating degenerative lumbar spinal disorders that have failed nonoperative interventions and require fusion with or without decompression. mTLIF is technically challenging and requires significant experience with percutaneous instrumentation and microsurgical decompression techniques, which contributes to variability among surgeons and a challenging learning curve. Based on our extensive experience, we present a tenstep technique for performing mTLIF that integrates advanced technologies to enhance safety, efficiency, and reproducibility, and describe minimally invasive extraforaminal lumbar interbody fusion (mELIF), an intertransverse approach that serves as a valuable alternative—particularly in revision surgeries or cases with significant foraminal pathology—by minimizing dural exposure and reducing incidental tears. The objective is to present our experience and provide recommendations through detailed ten-step workflows for performing a total three-dimensional (3D) navigated tubular mTLIF and mELIF using expandable interbody cages and single-step navigated pedicle screws. We retrospectively reviewed our experience with mTLIF and mELIF procedures, based on a total of 350 cases, to develop step-by-step surgical techniques and workflows. These techniques were supplemented by illustrations and operative videos demonstrating the key steps. Our overview documents the key technical details for the reliable and reproducible performance of mTLIF and mELIF. Across 350 patients, complications occurred exclusively in the mTLIF cohort (2.1%), including cerebrospinal fluid (CSF) leak, wound infection, and hardware complications, with no neurological complications reported. Median hospital stay was shorter for mELIF (24 hours) compared to mTLIF (48 hours) . Median follow-up time was 2.0 years. We present a comprehensive ten-step workflow for navigated mTLIF and mELIF. This workflow integrates three key features: (I) total 3D navigation, eliminating radiation exposure for the surgical team while minimizing radiation to the patient; (II) the use of expandable cages to enhance segmental lordosis; and (III) single-step navigated pedicle screws designed to streamline the surgical workflow. By providing clear and standardized workflows, we aim to support the  \neducation and training of surgeons, enabling consistent and safe outcomes.  \nKeywords: Minimally invasive spine surgery (MISS); minimally invasive transforaminal lumbar interbody fusion  \n(mTLIF); minimally invasive extraforaminal lumbar interbody fusion (mELIF); navigation; surgical workflow  \n^ ORCID: 0009-0007-4095-0798.  \n© AME Publishing Compan","cbCaimTnSmTBjMDK","https://ap.wps.com/l/cbCaimTnSmTBjMDK","pdf",1987785,16,"English","# Introduction\n## Surgical highlights\n## What is conventional and what is novel/modified?","[{\"question\":\"What is the purpose of the ten-step workflow for navigated mTLIF and mELIF?\",\"answer\":\"It provides standardized, detailed step-by-step surgical guidance to improve safety, efficiency, and reproducibility when performing total 3D navigated tubular mTLIF and mELIF.\"},{\"question\":\"How does mELIF differ from mTLIF in surgical approach?\",\"answer\":\"mELIF uses an extraforaminal, intertransverse corridor that avoids canal entry and limits dural manipulation, making it a particularly valuable option for revisions and significant foraminal pathology.\"},{\"question\":\"What were the reported outcomes and complications across the 350 cases?\",\"answer\":\"Complications occurred exclusively in the mTLIF cohort (2.1%), including CSF leak, wound infection, and hardware complications, with no neurological complications reported; median hospital stay was shorter for mELIF (24 hours) than for mTLIF (48 hours).\"}]","Ten-step technique for navigated tubular transforaminal and extraforaminal lumbar interbody fusion | PDF",1790734087]