Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF)
A transforaminal lumbar interbody fusion (TLIF) is a surgical procedure that stabilizes the spine and reduces back and leg pain by joining two or more vertebral bones to prevent abnormal movement.
Who is a candidate for a TLIF?
Patients with back pain and leg pain, weakness, or numbness who have failed conservative measures (physical therapy, medication, injections, etc.) and who have evidence of disc degeneration or instability on MRI are candidates for a TLIF.
What is a minimally invasive surgical approach?
Minimally invasive spine surgery is performed through small incisions in the back and uses intraoperative X-ray, microscope, tubular retractors, and special instruments to avoid extensive damage to the back muscles.
Minimally invasive surgery has many advantages over traditional (or open) spine surgery that include smaller incisions, less surgical blood loss, smaller scars, a shorter hospital stay, less pain during recovery, and a faster return to work and daily activities.
What happens during surgery?
The patient is brought to an operating room and placed under general anesthesia with a breathing tube for the duration of surgery, usually about 3-4 hours for a one-level procedure. X-ray is used to plan two small (about 2 inches long) lower back incisions – one on each side of midline – through which the surgery is performed. If intraoperative CT scanner and 3-D navigation are used, a small incision is also made over the pelvis in order to attach the navigation frame.
Without cutting through the muscles, a series of dilators are used to separate muscle fibers and provide access to the spine. A retractor is placed over the dilators and provides a working channel to perform the surgery. A microscope is then used to provide a close-up view during the procedure.
Bone spurs and overgrown ligament are removed in order to create more room for nerves in the spinal canal. Most of the disc between the vertebrae is then removed to create space for fusion between the bones. A synthetic spacer packed with patient’s own bone chips and synthetic material is then inserted between the vertebrae. The spacer provides support to the spine and aids bone fusion. Additional synthetic material is placed around the spacer to stimulate bone growth.
Titanium screws are inserted into the vertebrae above and below the spacer and connected together with titanium rods. This provides support to the spine while the bones fuse together over time. The screws and rods do not need to be removed and do not set off the metal detector at the airport.
The incisions are then closed with sutures that stay under the skin and dissolve over time, so no suture removal is necessary. Sterile dressings are placed that stay on for two days. If the surgery involves 2 or more levels or if the patient has risk factors for fusion not taking, a lumbar brace and/or a bone growth stimulator is worn for 6 weeks after surgery; otherwise, no brace is necessary.
What is the recovery like?
The patients typically spend 3-4 days in the hospital. The main restrictions are no heavy lifting (no more than 10 lbs. for the first 6 weeks, no more than 20 lbs. for the next 6 weeks, and no more than 40 lbs. for the next 3 months) and no repetitive bending or twisting at the waist.
Most patients return to light duty or office-type work in 4-6 weeks, to light-to-medium labor in 3-6 months, and to heavy labor in 9-12 months. Physical therapy is started between 6 and 12 weeks if necessary.
What follow-up care is necessary?
The patient is seen one week after surgery, and then at 6 weeks, 3 months, 6 months, and one year after surgery. X-rays are performed along the way to assess progression of fusion.
What are the risks of a TLIF?
Permanent or serious risks are uncommon with a TLIF, and include bleeding, infection, nerve injury, failure of fusion to take, loosening or breakage of screws/rods, and failure of symptoms to resolve.
What are the benefits of a TLIF?
The main purpose of a TLIF is to improve back and/or leg pain. Chances of success depend on many factors, including the type of problem seen on MRI, duration of symptoms, and degree of nerve damage. Patients who are good candidates for a TLIF often experience dramatic improvement in back and leg pain after recovering from surgery.