People with serious pain in their lower backs along their lumbar spine often find that fusion surgery may be their best option. One of the procedures we use for this is the transforaminal lumbar interbody fusion, or TLIF.
We perform the TLIF procedure through an incision made in the patient’s back. This approach can be advantageous since it avoids interfering with the many organs and major blood vessels that are present in the abdominal region. Interbody fusion involves removing an intervertebral disc, replacing it with a spacer and fusing the two vertebrae on either side of the spacer together.
The goal of the TLIF is to provide relief from the pain associated with a number of lower back problems such as spondylolisthesis and disc degeneration, which have not responded to non-surgical treatments.
We perform the TLIF procedure with the patient under general anesthesia, positioned face down on the operating table. We then make either a single midline incision or two incisions, each spaced about 5 centimeters to the side of the midline. After retracting the muscles, we then insert an imaging device (fluoroscopy) to ensure that the precise vertebrae are targeted.
We then remove the lamina (the bone covering of the spine) and trim back any excess bone to provide an unobstructed view of the nerve roots and to ensure that the nerves are free from compression. We then remove the injured disc and any debris, which creates a space for the nerves that have been compressed, relieving pain and symptoms in the lower back and legs.
To fill the space that has been created, a cage (or spacer) is then inserted in the disc space. The cage is typically made of either titanium or plastic and packed with bone graft. After inserting the cage, we then place screws and rods in the vertebrae to maintain stability of the spine around the cage. The spinal instrumentation secures the vertebrae in place, maintaining spinal stability as the vertebrae grow together and fuse.
After undergoing a TLIF procedure, a patient typically remains in the hospital for one or two nights. A physical therapy regimen is started soon after to assist the patient in regaining strength and mobility. Certain activities are restricted during the recovery period, including heavy lifting, twisting the midsection, and bending at the waist. Many patients can return to work within a few weeks after the procedure if their employment does not require strenuous exertion. However, heavy lifting and manual labor are prohibited for 3 – 6 months after the procedure, depending on the extent of the surgery.