Transforaminal Lumbar Interbody Fusion (TLIF)
Transforaminal Lumbar Interbody Fusion
When a patient has degenerative disc disease, recurrent disc herniations, or spondylolisthesis, there can be significant pain in the legs and lower back. Fusing two or more discs together can alleviate that pain by stabilizing the spinal vertebrae and the disc between them. If possible, Dr. Albert prefers to use the transforaminal lumbar interbody fusion (TLIF) technique for spinal fusion. He believes TLIF delivers excellent outcomes in the appropriate patient population.
What is transforaminal lumbar interbody fusion?
TLIF is a technique used for spinal fusion that inserts a bone graft and an artificial disc spacer into the area of the degenerated disc through a lateral approach to the spine. To gain access, only the facet joints on one side of the posterior spine are removed. This approach results in less disturbance to the nerve roots, reducing the risk of scarring or injury to them. The end result is the same as in other fusion techniques — fusion of two or more discs and stabilization of that part of the spine.
Who should consider having TLIF surgery?
Degenerative disc disease isn’t really a “disease” but a term that describes how the spinal discs change with age. The discs consist of outer membranes of connective tissue enclosing soft, jellylike material in the middle. They act as shock absorbers between the vertebrae of the spine, allowing the spine to twist, bend, and flex.
As we age, the spinal discs break down (degenerate) and become less fluid. They can flatten and push outward (herniate), pushing on nearby nerves or the spinal cord. The disc’s outer membrane can tear, also impacting the spinal cord and nerves. Degenerative disc disease often will lead to the need for disc fusion to alleviate pain in the legs and back.
Other patients needing fusion may have conditions such as spondylolisthesis, a condition in which one vertebra slips forward over the one below it, impacting the nerves and sending pain into the lower back and/or the legs. Spinal stenosis, where the nerves exiting the spine become compressed either by bone spurs or a narrowing of the spinal canal, can also lead fusion surgery.
A degenerated disc or nerve impingement in the lower back (lumbar) may result in pain in the back, buttocks, or legs. If the pain does not respond to nonsurgical treatments, or even to decompression surgery to relieve compression, it may be time to consider fusion. Odds are the pain will increase and begin to impact your quality of life.
What is the TLIF procedure?
Prior to the TLIF procedure, bone graft material is taken from the patient’s hip, through a small incision. This material will be used to fuse the vertebrae. Now the TLIF procedure proceeds.
- An incision is made on the back at the site of the damaged disc. To gain access to the disc laterally, Dr. Albert first removes the facet joints (part of the back side of the vertebra) on one side.
- Next, the damaged disc is partially removed, leaving some of the disc wall to help contain the bone graft material.
- An interbody spacer is inserted into the empty disc space. This will return proper spacing between the vertebrae, lifting the pressure from the nerve roots that are being pinched or compressed. The area is also filled with morselized bone to aid in the fusion of the two vertebrae.
- Screws and rods (one on each side) are inserted to add additional support between the vertebrae being fused. Bone graft material is placed over these rods on the sides of the spine. This morselized bone will grow all around and through the rods to form a bone bridge on both sides of the two vertebrae.
- The incision is closed and the procedure is finished.
Why is TLIF a better technique for spine fusion?
There are various techniques that can be used to fuse two vertebrae together, but Dr. Albert uses TLIF when possible. These are the advantages of TLIF:
- Bone fusion has three strong sites, on both gutters of the posterior of the spine, and inside the disc space.
- The spacer inserted into the middle of the empty disc opens the space back up, alleviating the pressure on the nerve roots.
- By being able to access the disc area from one side, the nerve roots don’t need to be retracted as much. This reduces the chances of injury and scarring, and it makes for a somewhat easier recovery.
What will my post-operative care be like?
Lumbar fusion surgery is major surgery. Most patients having TLIF surgery will stay in the hospital for between one to three days. Physical therapy begins the day after surgery. You will have to limit your activity, making sure to avoid twisting the spine, but walking during your recovery will be important. The worst pain will generally be over by two to three weeks after your surgery.
The period from one to three months after your TLIF surgery is a crucial time for the fusion mass to become solid. You will need to avoid certain activities (such as running or jogging) during this time period.
After three months, the fusion will have set. Now exercise to stress the area actually helps it become stronger. Exercise and physical therapy are an important component of a successful final outcome.
After six-twelve weeks, many patients can return to work, but overly strenuous jobs may take up to six months to be ready.
Success rates and risks with TLIF surgery
When considering TLIF surgery, you’ll of course have to weigh the benefits against the potential complications and risks. TLIF spinal surgery generally results in solid bone fusion and good pain improvement, but there are risks. These include the risks of any major surgery (infection, anesthesia reaction, etc.), along with nerve injury, lack of solid fusion between the vertebrae, or continued pain.
Studies of TLIF surgery show that a majority of patients report a 60 to 70 percent improvement in pain and are able to return to their normal activities.