Transforaminal Lumbar Interbody Fusion


The NuVasive MAS (Maximum Access Surgery) TLIF is a minimally invasive back surgery procedure.   It is a San Antonio minimally disruptive, pedicle-based surgery accessing only one side of the back using a novel access retractor called MaXcess.

What is Transforaminal Lumbar Interbody Fusion (TLIF)?

In a TLIF, rather than starting from the center and stripping the back muscles outward, the surgical approach starts at an angle to the spine and bluntly separates (rather than cuts) back muscles on just one side.  This procedure should reduce the approach-related muscle pain often seen in traditional back surgeries by minimizing the amount of muscle and tissue disruption.

The surgery offers the same advantages as traditional posterior interbody fusion, but with the added benefit of less tissue disruption and therefore less postoperative pain and quicker recovery.

MAS TLIF Surgical Procedure

The surgery is performed with the patient in the prone position.  X-ray floroscopy demonstrate the disc space and pedicles. K-wires are placed in the adjacent pedicles, and pedicle screws with MaXcess® retractor blades are placed over the wires using the NeuroVision® System which assists with pedicle screw and implant placement by monitoring nerve activity throughout the surgical procedure. The MaXcess® retractor blades are attached to the pedicle screws then the MaXcess® retractor is applied to the blades and surgery is ready to begin. The MaXcess® retractor from NuVasive offers improved visualization, and increased angulation during positioning of instruments and implants. With the disc space visible and accessible, San Antonio spine surgeon Dr. Guy Fogel then removes the disc material and prepares the disc space for fusion.

With the disc space prepared, spine and back surgeon Guy Fogel, M.D. of San Antonio then places an intervertebral implant and bone graft materials into the empty space to restore the proper disc height and support the loads put on that spinal segment and create an interbody fusion.  Once the intervertebral implant is in position, the retractor blades are exchanged for pedicle screw tops and a rod is secured for fixation support of the interbody implant. The retractor is removed and pedicle screws may implanted through a small incision on the opposite side, also using NeuroVision guidance.

The final result will be a combination of an intervertebral disc space where the fusion will occur, and the pedicle screw fixation posteriorly to stabilize the spine.  The small skin incisions are closed with a closure beneath the skin.

Because this procedure is less disruptive than conventional posterior surgery, most patients are able to get up and walk around the evening after surgery.  Most MAS TLIF patients are discharged from the hospital the next day, but your physician and health care team will determine the best postoperative course for you.

Spine Surgeon, Dr. Guy Fogel of San Antonio, TX is pleased to offer the MAS TLIFprocedure as a reasonable minimally invasive spine surgical option for you.  We hope that you are able to enjoy the benefits of this minimally disruptive approach to back and spine pain relief.


We accept Medicare and most Medicare Replacement plans. Call us to find out more 210-672-2812

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Spine Pain Be Gone

  • Back Neck and Spine Pain Stops Now


    Are you in need of back pain treatment? Looking for a back doctor in the San Antonio, TX area? Dr. Fogel of the Spine Pain Be Gone Clinic offers an alternative to traditional open back and neck surgeries. Utilizing world-class technologies and highly-advanced tools, Dr. Guy Fogel specializes with innovative minimally invasive spine surgery techniques for his patients.



    Common Conditions & Treatments


    Dr. Fogel offers his patients less painful and time-consuming surgical procedures as compared to traditional open back and neck surgeries, motion limiting fusion surgeries and artificial disc replacements.  He does this by utilizing the latest technologies and techniques for pain causing neck and back conditions through minimally invasive endoscopic procedures. 




Words from our patients

  • Vitals

    "He is warm, friendly, courteous and polite. He takes his time and answers all your questions. He did a lumbar fusion on me and I have had no problems."

    Verified Patient
  • Demandforce

    "Dr. Fogel is the most caring Dr. I have ever met. He always takes the extra time to make sure I understand everything that is going on in my treatment."

    Elizabeth S.
  • Demandforce

    "The best doctor I ever met and his staff go way beyond expectations to try to help. Seeing him was the best thing I ever did."

    Ronald P.
  • Demandforce

    "Dr. Fogel's surgical procedure on my spine three years ago totally eliminated my back pain. I highly recommend Dr. Fogel to any one needing back pain relief."

    Luis J.
  • Demandforce

    "He is an awesome doc! I highly recommend Dr. Fogel. I can say that I have my life back and can do a lot of things that I couldn't do before my surgeries."

    Joanne G.
  • Demandforce

    "They do their utmost best to get their patients back to living as well and as actively as possible. You will not find a better spinal team!"

    Michele P.
  • Demandforce

    "Dr. Fogel is awesome! He was very clear on my diagnosis and his recommendation of the procedure that I needed to fix the problem in my spine."

    Jaclyn R.
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Guy Fogel, MD, FAAOS
2833 Babcock
Suite 306
San Antonio, TX 78229