TLIF

What is a TLIF Procedure?

Transforaminal lumbar interbody fusion (TLIF) refers to a surgical approach that involves the fusion of some spinal bones. Surgeons perform this operation to remove an intervertebral disc and fuse two or more vertebrae together by using a screw and a cage in the lower back.

TLIF makes a permanent union of two or more spinal bones and performed for several reasons. Basic indications of TLIF include ¹:

• Degenerative disc disease
• Herniated disc
• Fractured vertebra
• Foraminal stenosis
• Spinal deformities like kyphosis
• Spinal instability or weakness
• Infection of the spine
• Tumor in the spine
• Severe lower back pain
• Mild to moderate scoliosis, a condition which makes the spine curve
• Spondylolisthesis, a condition where one vertebra slips on another vertebra

Who is an ideal candidate for a TLIF procedure?

Surgeons will not recommend doing this operation in patients having those problems ²:

• Those who suffer from osteoporosis
• Those who undergo spinal fusion at the same level of the spinal column
• Those who suffer from any conditions that may prevent proper fusion of the bone

An ideal candidate should possess some conditions like spinal instability, weakness, or pain caused by several reasons and already tried nonsurgical conservative treatments. Normally, spinal fusion changes the normal movement of the spine and reduces the pain level. You need to discuss the benefit and risks of this operation with your doctor. Your surgeon will help you to decide the best approach for the TLIF procedure.

How do Neurosurgeons perform a TLIF procedure?

TLIF procedure requires a professional medical team led by an expert neurosurgeon with an anesthesiologist and nurses to perform successfully. The entire operation can take as little as 2 hours, and as long as 6 to 7 hours to complete. The basic steps include ³:

• You need to lie on your stomach with pillows supporting each side of the body.
• Anesthesiologists will administer general anesthesia to fall asleep so that the patient will not feel any pain or sensation.
• Nurses will prepare the incision site.
• Doctors will monitor the vital signs of the patient’s body such as heart rate, respiratory rate, etc.
• Your surgeon will give a small incision at the back of the spine.
• The back muscles need to split to create a path towards the spine.
• Your surgeon will remove the part of the lamina and facet joints to open the spinal canal and enlarge the foramen.
• Surgeon will remove the ligament, bone spurs, and disc nucleus.
• Part of the disc will hold the bone graft cage and the surgeon will apply the surgical hardware to the spine to enhance bone fusion.
• A trial spacer needs to insert into the empty disc space properly to support the vertebral body.
• Your surgeon will place two sets of screws into the bone (above and below the disc space) and a rod to connect these together.
• Finally, surgeons will put back the muscles and other tissues in place and suture the skin together.

What does the recovery from a TLIF procedure look like?

Research shows that TLIF spinal fusion surgery improves the patient’s condition at 60% to 70%. Approximately 80% of the patient shows their satisfaction after TLIF fusion surgery.

During any operation, complications may arise. Potential complications of TLIF include ⁴:

• Failure of the vertebra to fuse
• Hardware malfunction
• Migration of bone graft
• Infection in the surgical site
• Excessive loss of blood
• Formation of a blood clot
• Spinal nerve damage
• Chronic back pain
• Partial paralysis

A follow-up monitoring for 24 to 48 hours requires the patient after surgery. The patient will take 4 to 6 weeks for a full recovery ⁵. In the case of any complications, consult with your surgeon immediately.

References

1. Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. Journal of spine surgery (Hong Kong). 2015;1(1):2–18. doi:10.3978/j.issn.2414-469X.2015.10.05
2. de Kunder SL, van Kuijk SMJ, Rijkers K, Caelers IJMH, van Hemert WLW, de Bie RA, van Santbrink H. Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine Journal. 2017;17(11):1712–1721. https://doi.org/10.1016/j.spinee.2017.06.018. doi:10.1016/j.spinee.2017.06.018
3. Hey HWD, Hee HT. Lumbar degenerative spinal deformity: Surgical options of PLIF, TLIF and MI-TLIF. Indian Journal of Orthopaedics. 2010;44(2):159–162. doi:10.4103/0019-5413.62066
4. Hammad A, Wirries A, Ardeshiri A, Nikiforov O, Geiger F. Open versus minimally invasive TLIF: Literature review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2019;14(1):1–21. doi:10.1186/s13018-019-1266-y
5. Hari A, Krishna M, Rajagandhi S, Rajakumar D V. Minimally invasive transforaminal lumbar interbody fusion-Indications and clinical experience. Neurology India. 2016;64(3):444–454. doi:10.4103/0028-3886.181536