Transforaminal Interbody Fusion (TLIF)
A transforaminal lumbar interbody fusion (TLIF) is a minimally invasive procedure used to treat lower back and/or extremity pain that is caused by a diseased or damaged lumbar intervertebral disc. What distinguishes a TLIF from other lumbar fusion procedures is the approach. A posterior lateral (from the back and slightly to the side of the midline) incision is made to access the lumbar spine without having to move or retract the spinal nerve roots. This type approach is advantageous to patients because they experience less post-surgical pain and recover faster from surgery.
A TLIF may be recommended when symptoms associated with the following conditions do not respond to non-surgical treatment options:
The goal of surgery is to decrease symptoms by treating their cause. As with all lumbar spinal fusion procedures, this goal is accomplished through the restoration of vertebral height, decompression of nerve roots, and fusion of adjacent lumbar vertebrae.
Conditions Treated by TLIF
Conditions such as spondylolisthesis, degenerative disc disease or recurrent disc herniations are known to produce mechanical pain and may be indications for a spinal fusion.
Non-smoking patients in good medical condition are candidates for a TLIF procedure. If lower back and/or extremity pain is ruining your quality of life, do not delay a diagnosis—please, contact DISC of Louisiana to arrange a one-on-one consultation.
Benefits of TLIF
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.
The TLIF Procedure
A TLIF is performed on an inpatient basis under general anesthesia. After the patient is comfortably positioned and asleep, the surgeon use a portable x-ray machine to visually locate the diseased vertebra. A one-inch incision is made directly above the problem vertebra.
The following steps are performed:
- Accessing the vertebra. A series of tubes, called dilators, are carefully passed through muscles and the surrounding soft tissue with the guidance of the portable x-ray. A tubular retractor is slid over the dilators and they are removed. This creates a working channel for the surgeon. This process allows the surgeon access to the target vertebra with minimal incision pain and muscle scarring.
- Visualization. A portion of the vertebral facet joint is removed so the surgeon can view and operate on the lumbar vertebra that is causing symptoms.
- Disc removal. The inner portion of the disc is removed. The outer vertebral wall is left in place.
- Implant insertion. A metal cage spacer packed with bone graft is placed into the disc space against the vertebral wall. Additional bone graft is packed into spaces around the implant.
- Fixation. Special screws known as pedicle or facet screws are used to fixate adjacent vertebrae to one another.
- Incision closure. The incision is closed and sterile dressings are placed over it.
Following the procedure, the patient is brought to the post operative recovery room. After the effects of surgical anesthesia and pain medications wear off, the patient is brought to their comfortable hospital room where they will stay for 1-3-days. During that time, post operative pain will be controlled and physical therapy will be started.
Symptom relief occurs as bone graft fuses with existing bone and creates a single, solid vertebra that does not compress the spinal cord or nerve roots. Patients who undergo a TLIF experience marked improvement in their quality of life and ability to perform physical activities. In most cases, patients are able to return to activities that they once loved, but were unable to perform because of their spine condition.
If you have questions about spinal stenosis or the minimally invasive spine procedures offered by DISC of Louisiana, please contact us to schedule an evaluation at one of our clinics across the south Louisiana region.
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