Dr. Kremer specializes in Minimally Invasive TLIF (Transforaminal Lumbar Interbody Fusion), a procedure that is an effective and safer alternative to “open” fusion surgery.

Same Spine, Same Pathology. A Totally Different Outcome.

Stories of limited success in back surgery have historically been the norm; as a result, fewer than 5% of degenerative disk disease patients chose surgery. Why is that? Primarily because the risks associated with traditional ‘open’ back surgery were high, the results were far from guaranteed, and the recovery could be lengthy and painful.

In a minimally invasive TLIF, the surgeon inserts a small tube through the skin to access the pathology with the use of a camera. By using small, specialized surgical instruments in conjunction with a microscope, the surgeon can perform the entire TLIF procedure through the tube. This reduces the size of the incision, avoids cutting muscles, and leads to less blood loss and less risk of infection. Patients are often released from the hospital after an overnight stay, or even the same day, rarely requiring pain medication.

MIS TLIF treatment for Degenerative Disk Disease

Approximately 80% of people experience low back pain in their lifetimes. Although not every case of back pain is caused by degenerative disk disease (DDD), this problem does account for many back pain issues. DDD is an abnormal condition affecting the intervertebral disks that cushion each vertebra of the spine. In the lower back or lumbar area, there are five separate vertebrae. They serve to allow the spine to flex, extend, bend, and rotate.

Aging causes intervertebral disks to lose their water content, leading to shrinkage, increased rigidity, and loss of disk height. This decrease in disk space means the vertebrae are closer together, which can hinder specific movements or cause pain with different activities. The nerves become compressed or pinched. Overall, there is less shock absorption, especially with walking, running, or jumping. Additionally, lifting heavy items incorrectly, twisting while lifting, and trauma can all damage the disks.

MIS TLIF Treatment for Spondylolisthesis

Another common cause of lower back pain is lumbar spondylolisthesis, the medical term for shifting in the proper vertebral alignment. In other words, one vertebra shifts forward onto the vertebra below it. Trauma can cause spondylolisthesis but so can routine, long-term participation in sports ranging from gymnastics to football.


Degenerative disk disease and spondylolisthesis both have similar symptoms. Early signs include low back pain, particularly with motion, and tenderness in the lower back. These symptoms then typically progress to pain with extended periods of sitting or standing and a sensation of catching in the back. At this point, pain and motion restrictions may keep you from walking normally.

The later stages of degenerative disk disease or spondylolisthesis typically lead to numbness, tingling, and pain in the buttocks and legs. Remember that the nerves leading to the legs exit the spinal cord at the lumbar level, so problems in the lumbar spine can lead to symptoms in your lower extremities.

Motion Preservation Fusion

When back problems like spondylolisthesis and degenerative disk disease have progressed to the point that surgical treatment is required, the procedure of choice is usually a lumbar fusion. In this surgery, your surgeon will use small hardware to join or fuse two or more lumbar vertebrae.

This fusion helps to stabilize your spine, correct any misalignment, and prevent further problems. By fusing lumbar vertebrae, your surgeon can maintain both stability and disk height, and with the minimal implants preserve a more natural range of motion.? A lumbar fusion not only takes the pressure off the spinal cord or pinched nerve, but the procedure also addresses the problem that caused the pinching in the first place.

A transforaminal lumbar fusion may be single-level or multilevel. Possibilities include fusion between any of the five lumbar vertebrae and fusion to the first sacral vertebra.

Open Surgery Issues

Until recent advances, back surgeries involved large incisions, the relocation of muscles and nerves, and tying off blood vessels. Through this extensive incision, the surgeon gained access to the vertebrae and disk spaces. All of this cutting and movement are the reasons that patients face a long and painful recovery period of many months. Complications such as bleeding, nerve damage, and infection are higher with open surgery. Patients require more extended hospitalization and more pain medications such as addicting narcotics. As a result, people did not usually undergo open surgery unless there were significant neurologic complications involving the bowel, bladder, or the inability to walk due to nerve damage.

Surgeons such as Dr. Kremer, have a remarkable track record using minimally invasive TLIF (Transforaminal Lumbar Interbody Fusion). The MIS-TLIF allows Dr. Kremer to access the pathology (problem) quickly by approaching from slight angle through a very small channel. As a result, Dr. Kremer often completes the procedure in less time required for traditional surgeons to open access to the area needing surgery.

MIS TLIF Benefits Include:

  • Smaller incision means less pain and a smaller scar
  • Less cutting of muscle for less pain and fewer complications
  • Less risk of nerve damage
  • Greater muscular stability
  • Less blood loss
  • Less risk of infections
  • Less hospital time- only one to two days compared to seven or more
  • Less addicting narcotic medication for intense pain control

MIS TLIF Research Results

A recent study of minimally invasive TLIF operations showed amazing results. Patients underwent the procedure, with nearly all the patients having suffered from both low back pain with movement and pain from pinched nerve roots. The remaining patients had low back pain alone. One-fifth of the patients had prior surgeries for the same condition.

After their procedures, all patients reported improvement in their symptoms. Even the patients with mechanical low back pain alone reported less overall pain. Eighteen months after their surgeries, all patients showed evidence of successful fusions.

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