Transforaminal lumbar interbody fusion (TLIF) is a surgical technique where the surgeon is able to remove overgrown bone and joints causing nerve compression, remove abnormal disc and restore height with a specialized cage, and stabilize the spine using screws and rods.
This surgery provides direct and indirect decompression of the spine and affords stability to the spine by fusing two segments together.
During TLIF surgery, the patient is placed on a special bed in the face down position.
An incision is made either directly midline (in open surgery), or off to either side (in minimally invasive surgery).
Muscle is either dissected away (in open surgery), or serially pushed aside with expanding retractors in minimally invasive surgery. This gives access to the spine.
The surgeon then uses specialized ronguers, curettes, and a high-speed drill to remove the patient’s bone, lamina, and a portion of the joints to gain access to the spinal canal.
By doing so, the surgeon is able to directly decompress the spinal nerves.
The surgeon then carefully retracts the nerves, removes the abnormal disc material, strips the end plates of cartilage, and sequentially dilates and spreads the bones apart and restore normal height.
The implant specifically suited for the patient is then identified and a trial implant is placed under X-ray to confirm placement and sizing.
Once the correct size has been found, a permanent cage, either made from bone, special plastic, or metal, is filled with bone graft and placed between the two vertebral bodies.
TLIF is usually performed with the assistance of a microscope or surgical loupes (magnifying lens) to provide maximum surgical visualization. Dynamic X-ray (fluoroscopy) is used to assist the surgeon throughout the procedure.
TLIF also uses screws and interconnecting rods to promote surgical stabilization of the bones while the body naturally fuses the spine segments together.
TLIF works by using multiple mechanisms.
First, the direct removal of bone and ligament provides more room in the spinal canal, making nerve roots free from compression.
Next, the removal of the damaged disc and cartilage allows for a cage to be inserted and the disc space to be reestablished to a normal height. When a normal height is achieved, the nerve roots are better able to pass through without any compression.
Finally, the spine is reconstructed with rods and screws to hold the spine in alignment while the body fuses the bones together.
This combination of decompressing the nerve roots, restoring disc height and stabilizing the bones typically leads to significant improvement of a patient’s leg symptoms and even back pain in certain cases.
Surgeons consider TLIF’s the workhorse of their arsenal because of its versatility.
First, it allows direct visualization and decompression of the spinal cord and nerves.
Next, it allows for placement of a cage in the disc space to allow for rebuilding of normal height and lordosis that is often lost with age and arthritis.
Lastly, in spondylolisthesis, or slips, it can reduce the deformity while providing immediate stability.
Patients can expect to stay in the hospital for less than two days following minimally invasive TLIF surgery.
Most patients spend one night in the hospital, and more than half of patients leave the hospital within 24 hours of surgery.
When TLIF is part of a multi-level procedure, patients require a longer hospital stay.
Patients may be instructed to wear a back brace for up to 1 month.
Physical therapy is typically prescribed a month after surgery to work on flexibility, core strengthening, and range of motion to aid surgical healing.
Patients typically return to their baseline level of functioning in 4-6 months.
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