The posterior lumbar interbody fusion (PLIF) was born in the 1950s, and the fusion rate was significantly increased and the clinical outcome improved because of the adequate implant fusion bed, rich blood supply and good biomechanical environment. However, PLIF surgery requires extensive paravertebral muscle stripping on both sides of the lumbar spine, resulting in a certain degree of postoperative denervation of the paravertebral muscle; it requires removal of more posterior structures on both sides, such as the laminae and intervertebral tuberosities; and technically requires a certain amount of bilateral nerve root distraction, increasing the chance of nerve root injury. In 1982, Harms et al. proposed the technique of transforaminal approach to lumbar interbody fusion (TLIF), which generally does not require intraoperative distraction of the nerve roots, and these technical advantages have led to the rapid promotion of the TLIF technique. However, the muscle approach to surgery has not changed, and the disadvantage of muscle damage from open lumbar posterior TLIF surgery still affects the long-term efficacy of TLIF surgery. In 1997, Foley and Smith proposed the tubular retractor technique, which solved the problem of minimally invasive access to the posterior spine and reduced the strain and stripping of the paravertebral muscles during routine posterior lumbar surgery. 2001, Foley proposed the percutaneous pedicle screw technique, and minimally invasive lumbar interbody fusion came into being. In 2002, Koo first reported the minimally invasive posterior transforaminal lumbar interbody fusion (MIS-PLIF) technique, and in 2003, Foley first reported the minimally invasive transforaminal access lumbar interbody fusion (MIS-TLIF) technique. After nearly 10 years of development, MIS-TLIF has been continuously enriched and improved in terms of surgical techniques and indications, and has been accepted by more and more spine surgeons. Indications for surgery 1. lumbar spondylolisthesis; 2. recurrent disc herniation; 3. lumbar spinal stenosis; 4. lumbar degenerative lordosis and kyphosis. After studying in spine centers at home and abroad, attending relevant academic conferences and studying relevant materials, the authors have improved the instruments and techniques of minimally invasive lumbar interbody fixation and fusion (MIS TLIF) based on the comprehensive mastery of MIS TLIF technique, which has greatly reduced the learning curve and reduced the operation time and cost while retaining the advantages of the original technique. On the one hand, more doctors can master the technique, and on the other hand, more patients can benefit from it. Surgical technique 1. Decompression The surgical incision is determined with the aid of C-arm fluoroscopy. The intervertebral joints are marked on both sides, and in the orthogonal phase, the position of the pedicles above and below the operated intervertebral space is marked. Finally, the lateral line of the upper and lower pedicles is marked. The surgical incision is made on this line. The incision is 2-3 cm long and is usually located 2 fingers from the midline. After dissecting the deep fascia, the gap is separated along the Wiltse approach lateral to the paravertebral muscle. A grade-by-grade retraction canal is placed, and after completion of expansion, the bottom of the working channel is placed in the intervertebral small joint complex and the fixation arm is screwed. For unilateral nerve root compression, the incision is chosen on the symptomatic side. The inferior and partial superior articular processes are removed to completely expose the intervertebral foramen and relieve the nerve compression. If the patient has central spinal stenosis or contralateral lateral spinal stenosis, the surgical bed can be tilted to the contralateral side and the working channel can be tilted inward to clearly reveal the thickened ligamentum flavum and the hyperplastic bone, and adequate decompression can be achieved with a lamina bite forceps or a high-speed grinding drill with curvature. 2, intervertebral space preparation and intervertebral fusion Under the working channel, intervertebral spacers are placed step by step to remove the cartilage endplate and most of the fibrous ring and nucleus pulposus, and to reveal the bony endplate. After completion of the intervertebral space preparation, the intervertebral bone graft fusion operation was performed. Autologous three-sided cortical iliac bone is the ideal material for bone grafting, but at the same time it brings additional surgical trauma and causes complications in the bone extraction area. As an alternative, a commonly used option is to apply an intervertebral fusion device (Cage) with built-in autologous cancellous bone, which can achieve a high fusion rate and clinical efficacy. Foreign scholars have used intervertebral fusion devices combined with recombinant bone morphogenetic protein-2 (rBMP2), etc., and have also obtained good results in clinical follow-up. The materials of fusion devices have also seen some improvements and innovations. From the initial titanium, polyetheretherketone with elastic modulus closer to that of bone tissue, to the degradable polymorphic material PL-DLA, etc. On the basis of intervertebral fusion, it can also be combined with posterior posterolateral bone graft fusion to achieve 360 degree fusion. 3. Percutaneous pedicle screw instrumentation The entry point for the pedicle screw is selected with the aid of C-arm fluoroscopy. Usually the entry point is located at the intersection of the line between the root of the transverse process and the base of the superior articular process. Compared with open posterior lumbar surgery, the pedicle screw entry point can be more outward to obtain a greater inward angle and to increase the screw’s resistance to extraction. After deciding on the entry point, the arch puncture is performed with a Jamshidi needle, and the direction of entry is corrected by fluoroscopy in the ortho-lateral position. The ideal direction and depth of entry is such that the tip of the Jamishdi needle approaches the medial edge of the arch projection in the ortho-lateral phase, and the tip is entering the vertebral body in the lateral phase. After confirming the above direction and depth, the arch root guide pin is placed and the tapping of the arch root is performed with a hollow wire tapping. Attention should be paid to the position of the guide pin, both to prevent the withdrawal of the guide pin during operation and to bring in the guide pin during tapping, which may cause damage to internal organs and large blood vessels if it penetrates the front of the vertebral body. After completing the tapping, screw in the appropriate length of pedicle screw. Repeat the above steps to place the rest of the pedicle screws, place the fixation rods, perform segmental compression, restore the anterior lumbar convexity, and finally complete the fixation. Postoperative management The first day after surgery, the patient was allowed to move on the ground and was discharged within three days. Clinical outcomes In general, the efficacy of MIS-TLIF is comparable to that of conventional TLIF surgery, but has significant advantages in terms of surgery-related trauma, intraoperative bleeding, length of hospital stay, and recovery time. Several studies comparing the two-year follow-up results of MIS-TLIF and open-TLIF surgery have shown similar clinical outcomes, but MIS-TLIF has less pain in the early postoperative period, shorter hospital stay, early recovery, and fewer complications.The clinical outcomes of MIS-TLIF are no less than those of open-TLIF surgery; however, in terms of intraoperative bleeding, length of stay, intraoperative complications, and relative costs of surgery and treatment In terms of intraoperative bleeding, hospital stay, intraoperative complications and relative costs of surgery and treatment, MIS-TLIF has significant advantages.