Trans-lumbar posterior interbody fusion (PLIF) was born in the 1950s, and the fusion rate has improved significantly and the clinical outcome has 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 muscles; 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 retraction, increasing the chance of nerve root injury. 1982 Harms et al. proposed the technique of lumbar interbody fusion through the intervertebral foramen ( TLIF), which generally does not require intraoperative distraction of the nerve roots, and these technical advantages have led to the rapid expansion 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 outcome 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. The indications for surgery are 1. lumbar spondylolisthesis; 2. recurrent disc herniation; 3. lumbar spinal stenosis; 4. lumbar degenerative lateral and retrovertebral convexity. After studying in spine centers at home and abroad, attending relevant academic conferences and studying relevant materials, the authors, based on a comprehensive mastery of minimally invasive lumbar interbody fixation and fusion: the MIS TLIF technique, improved the instruments and techniques of minimally invasive lumbar interbody fixation and fusion, making the learning curve significantly lower, reducing the operative 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 2-75 px 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. After placement of the step-by-step retraction canal and completion of the expansion, the bottom of the working channel is placed in the intervertebral tuberosity complex and the fixation arm is tightened. In cases of 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 bed can be tilted to the opposite side and the working channel can be tilted inward to clearly reveal the thickened ligamentum flavum and the hyperplastic bone flab, and adequate decompression can be achieved with a lamina bite forceps or a high-speed grinding drill with curvature. 2. Interbody preparation and interbody fusion Under the working channel, interbody spacers are placed step by step to remove the cartilage endplates and most of the fibrous annulus and nucleus pulposus, and to reveal the bony endplates. During the operation, attention is paid to protecting the superior nerve root to avoid injury. After completion of the intervertebral space preparation, the intervertebral bone graft fusion operation is performed. Autologous trifacial cortical iliac bone is the ideal material for bone grafting, but it brings additional surgical trauma and causes complications in the bone extraction area. As an alternative, an intervertebral fusion device (Cage) with built-in autologous cancellous bone is commonly used to achieve high fusion rates and clinical outcomes. Foreign scholars have used intervertebral fusion devices combined with recombinant bone morphogenetic protein-2 (rBMP2), etc., and have achieved good results in clinical follow-up. The materials of fusion devices have also seen some improvements and innovations. From the initial titanium metal, polyetheretherketone with elastic modulus closer to 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 With the aid of C-arm fluoroscopy, the entry point of the pedicle screw is selected. 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 is punctured 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 of the needle is entering the vertebral body in the lateral phase. After confirming the above direction and depth, a guide pin is placed and the vertebral arch is tapped with a hollow tap. Attention should be paid to the position of the guide pin, both to prevent it from withdrawing during operation and to bring it into the process of tapping, which may cause damage to internal organs and large blood vessels if it penetrates the front of the vertebral body. After tapping is completed, the appropriate length of pedicle screw is screwed in. Repeat the above steps Place the remaining pedicle screws, place the fixation rods, perform segmental compression, restore the anterior lumbar convexity, and finally complete the fixation. Postoperative Service In general, the efficacy of MIS-TLIF is comparable to that of conventional TLIF surgery, but it has significant advantages in terms of surgery-related trauma, intraoperative bleeding, hospitalization time, and recovery time. Several studies comparing the two-year follow-up results of MIS-TLIF and open-TLIF surgery showed similar clinical outcomes, but MIS-TLIF had less pain in the early postoperative period, shorter hospital stay, early recovery, and fewer complications.The clinical outcomes of MIS-TLIF were not inferior to 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.