Transforaminal Lumbar Interbody Fusion (TLIF)

event 13.09.2012.

Spinal fusion (such as TLIF) is a surgical technique to stabilize the spinal vertebra and the disc or shock absorber between the vertebra. Lumbar fusion surgery is designed to create solid bone between the adjoining vertebra, eliminating any movement between the bones.

The aim of this surgery is to reduce pain and nerve irritation.

Spinal fusion may be recommended for conditions such as spondylolisthesis, degenerative disc disease or recurrent disc herniations. Surgeons perform lumbar fusion using several techniques. This article describes the transforaminal lumbar interbody fusion (TLIF) fusion technique.

Procedure for Spine Fusion Using TLIF Technique

TLIF back surgery is done through the posterior (back) part of the spine.

  • Surgical hardware is applied to the spine to help enhance the fusion rate. Pedicle screws and rods are attached to the back of the vertebra and an interbody fusion spacer is inserted into the disc space from one side of the spine.
  • Bone graft is placed into the interbody space and alongside the back of the vertebra to be fused. Bone graft is obtained from the patient’s pelvis, although bone graft substitutes are also sometimes used.
  • As the bone graft heals, it fuses the vertebra above and below and forms one long bone.

TLIF fuses the anterior (front) and posterior (back) columns of the spine through a single posterior approach.

  • The anterior portion of the spine is stabilized by the bone graft and interbody spacer.
  • The posterior column is locked in place with pedicle screws, rods, and bone graft.

Benefits of TLIF Back Surgery Technique

TLIF procedure has several theoretical advantages over some other forms of lumbar fusion:

  • Bone fusion is enhanced because bone graft is placed both along the gutters of the spine posteriorly but also in the disc space.
  • A spacer is inserted into the disc space helping to restore normal height and opening up nerve foramina to take pressure off the nerve roots.
  • A TLIF procedure allows the surgeon to insert bone graft and spacer into the disc space from a unilateral approach laterally without having to forcefully retract the nerve roots as much, which may reduce injury and scarring around the nerve roots when compared to a PLIF procedure.

As with all forms of lumbar spine fusion, prior to TLIF surgery medical clearance is obtained. Smoking should be stopped. Patients may require pre-donation of blood to be used at the time of surgery.

TLIF Back Surgery Technique

TLIF procedure is performed through a posterior incision exposing the back of the spine.

  • Pedicle screws are placed into the vertebra.
  • Exposure of the disc space is done on one side by removing the facet joints and protecting the nerve roots.
  • The disc space is entered and disc material is removed.
  • Bone graft is obtained from the patient’s iliac crest (the hip).
  • A spacer or interbody cage that is filled with bone graft is placed into the disc space to maintain the disc height.
  • Additional bone is placed in the lateral (side) gutters of the vertebra and the disc space.
  • Pedicle screws are attached to rods or plates.
  • The wound is closed.

Post-Operative Care After TLIF Back Surgery

After TLIF spinal fusion surgery, patients are admitted to the hospital for an average of three to five days. Blood transfusion may be required. Physical therapy begins the day after surgery, and patients are gradually mobilized. A spinal brace may be used.

Patients are discharged to be at limited activity on oral pain medicine and will follow up with the surgeon in several weeks. Patients can generally return to office work in four to six weeks, or longer if the patient’s occupation is heavier.

Potential Risks and Complications for TLIF Back Surgery

The benefits of TLIF spinal surgery must be weighed against potential complications from the surgery. Potential risks and complications include:

  • Anesthesia
  • Infection
  • Blood loss
  • Nerve injury
  • Possible re-operation
  • Lack of a solid fusion
  • Continued pain or (rarely) increased pain.

Medical complications include pneumonia, heart attack, stroke, or blood clots.

While complications are not common, there is no guarantee that spinal fusion will be completely successful. TLIF usually results in solid bone fusion with good pain improvement. Patients should review additional details with their surgeon so that all questions and concerns are addressed.