What is TLIF?
TLIF stands for Transforaminal Lumbar Interbody Fusion, a type of spinal fusion surgery.
This is one method of performing lumbar interbody fusion, wherein the degenerated disc is removed, and the space fused together with a bone graft/cage.
It is used to treat spinal instability and chronic low back.
Why is it done?
The surgeon may suggest TLIF as a treatment choice depending on various factors such as the patient's spinal condition, age, activity levels, and medical history. TLIF may be recommended for the following spinal instability conditions:
- Degenerative disc disease (involving a damaged disc)
- Spondylolisthesis (in which one vertebra slips over another)
- Spinal stenosis
What happens during the TLIF procedure?
Before the procedure, the patient will typically undergo a thorough evaluation by the surgeon to determine the underlying cause of their pain and whether a TLIF is an appropriate treatment option. This will also include an anaesthetic assessment for fitness for surgery.
The surgery is usually performed under general anaesthesia, and the patient lies face down on the operating table.
During a TLIF procedure, the surgeon makes a small incision in the lower back.
The surgeon retracts the muscles on one side to access the bony arch and roof of the spine (lamina). Then, the facet joint that is located above the nerve root is removed on the same side as the leg symptoms to explore the nerve root and ensure there is no pressure on it.
The disc is removed completely, leaving only the bone edge of the vertebral body (end plates). The space created is filled with bone graft and/or a cage and placed between the outer segment of the spine between the transverse process (inter-transverse region). The patient's own bone will gradually grow into the bone graft over time.
Screws and rods are fixed to stabilise the spine.
In cases with bilateral leg symptoms, further surgery may be required to relieve pressure from the opposite nerve root. To avoid retracting the other muscle from the lamina, the surgeon may perform a minimally invasive (tubular) decompression, which involves working through a narrow tube.
What happens after the procedure?
After the procedure, the patient is taken to a recovery room, where they are monitored briefly before discharge. Patients can usually return home after safely mobilising following the surgery. Depending on the case's complexity, this may be a day or a few days.
Patients are given pain medications to manage the discomfort. They may also be instructed to avoid bending, lifting, or twisting for several weeks. Patients may need to undergo physical therapy to strengthen their muscles and improve their range of motion. The recovery period varies for each patient, but most patients are off work for initial four weeks. If it’s a strenuous job, then you may be off for up to 8 weeks.
What are the potential side effects of the procedure?
As with any form of surgery, there are risks associated with it.
Possible some list of complications include:
- Nerve damage
- Blood clots
- Bowel or bladder problems
All the risks and benefits will be discussed during the consent process.
The primary risk of TLIF is the failure of vertebral bone and bone graft fusion, which may require additional surgery.
Please consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results, and other important medical information that pertains to the TLIF procedure.
Please follow the BASS (British Association of Spinal Surgeons) website for more information.
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