Abstract
The transforaminal interbody fusion (TLIF) is a time-tested procedure fortreating various lumbar degenerative pathologies. This approach leverages an accessroute through Kambin's triangle that typically requires a partial or total facetectomy foraccess to the disc space and neural decompression. Since its first published descriptionin the early 1980s, the procedure has undergone extensive refinements concomitantwith technology and technique advancements. Traditional open TLIF is effective butassociated with adverse perioperative effects due to the amount of muscle dissectionnecessary for exposure, including increased blood loss, hospital length of stay, andextended recovery times. The transition to more minimally invasive, paramedianapproaches has sought to reduce the burden of these consequences. Spinal endoscopyhas witnessed a resurgence over the past decade paralleled by advancements in higherresolution optical systems along with more robust and enduring endoscopicinstrumentation. This development, combined with increased awareness of healthcareeconomic costs, problems with narcotic dependency surrounding open spine surgery,and admission restrictions to hospitals during pandemic times, has fueled a push for“ultra minimally invasive variants of the traditional TLIF. Patients, payors, andhospitals alike expect shorter inpatient stays, earlier mobilization and discharge fromthe hospital, as well as narcotic independence faster than ever before. To this end,awake endoscopic TLIF has recently been described with efficacious results to complywith these broader factors. In this chapter, the authors explain their awake endoscopicTLIF step-by-step and demonstrate the clinical advantages and the noninferiority datato traditional MIS TLIF based on their clinical series's one-year outcomes data. nbsp;