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TLIF

Transforaminal lumbar interbody fusion (TLIF) is a surgical technique performed in order to stabilize the spinal vertebra and the disc or shock absorber between the vertebra.

This procedure is also called lumbar fusion surgery and is designed to create solid bone between the adjoining vertebra, eliminating any movement between the bones.

The goal of the surgery is to reduce pain and nerve irritation and is recommended for conditions such as:

• degenerative disc disease
• recurrent disc herniations
• spondylolisthesis

TLIF surgery is done through the posterior (back) part of the spine. The following steps are specific to TLIF surgery:

• 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
• 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
• 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

Bone graft is obtained from the patient's pelvis, although bone graft substitutes are also sometimes used.

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

• a TLIF procedure allows a unilateral approach 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
• bone fusion is enhanced
• the spacer helps restore normal height and opens up nerve foramina to take pressure off the nerve roots

Prior to TLIF surgery medical clearance is obtained, as with all forms of lumbar spine fusion. Patients are advised to stop smoking a few months prior to surgery and may also require pre-donation of blood to be used at the time of surgery.

According to studies, 60% to 70%  of patients experience a decrease in pain after TLIF spinal fusion surgery, and around 80% of TLIF patients are satisfied with the surgical result.

Potential risks and complications of TLIF include:

• anesthesia
• infection
• blood loss
• nerve injury
• possible re-operation
• lack of a solid fusion
• continued pain or (rarely) increased pain

TLIF usually results in a solid bone fusion with good pain improvement, although complications are rare, there is no guarantee that spinal fusion will be a complete success.

Here is an example of a patient who underwent a TLIF. She was suffering from back and mainly left leg pain due to spondylolisthesis at L4-L5. She failed conservative management in the form of physical therapy, activity modification, and oral medications. Her pre-op pain was a 9 out of 10. She underwent the TLIF procedure uneventfully and only two weeks after the procedure her pain is decreased from her pre-op pain.

Preoperative Lateral X-Ray
Pre-op lateral x-ray showing spondylolisthesis at L4-L5 (slipped vertebrae of L4 forward on L5) causing stenosis.

Preoperative MRI
Pre-op MRI showing severe stenosis due to the slip of L4 forward on L5.

Postoperative Lateral X-Ray
Post-op lateral x-ray showing PEEK spacer increased disc height, restored lordosis (normal curvature), and reduced slip of L4 on L5, thereby relieving stenosis. Additionally, pedicle screws provide stability to increase fusion success.