Transforaminal Lumbar Interbody Fusion (TLIF)

A transforaminal lumbar interbody fusion, or TLIF, is a minimally invasive procedure that is performed through the back only. Two small incisions are made on the right and left sides and then dilators are used to expand the surrounding muscle and expose the operative site. Bone is removed to expose the disc space. Small instruments are used to remove the disc material. An appropriate size spacer, containing bone from your pelvis, cadaver or other biologics, is placed between the two vertebrae. Any bony overgrowth or soft tissue compressing on the nerves is removed. Screws and rods are used to stabilize the bones. Intraoperative fluoroscopy, or x-ray, is used throughout the procedure to ensure proper placement of the spacer and hardware.

How long does a transforaminal lumbar interbody fusion take?

Transforaminal lumbar interbody fusion is an inpatient procedure that takes one to two hours, depending on the number of spinal levels involved. Patients arrive at the hospital one or more hours before their procedure to check in and prepare for post-operative workups as needed. The TLIF procedure is performed with general anesthesia, which means the patient is unconscious and monitored by a board-certified anesthesiologist.

How long does it take to recover from transforaminal lumbar interbody fusion?

TLIF is usually performed as an inpatient surgery. Patients may stay in the hospital for three to five days after their procedure, where they can receive necessary assistance from medical staff. Pain medication is administered at regular intervals to help manage comfort. Physical therapy may begin as early as the day after surgery.

Once discharged, patients are advised to limit physical activities for several weeks. Physical therapy continues and patients are encouraged to walk daily to promote good circulation and decrease the risk of blood clots in the legs. A surgical follow-up visit occurs several weeks after surgery. Until that time, patients should maintain the activity restrictions outlined in their discharge paperwork. The amount of time it takes to resume normal activities may differ from one person to another. Generally, we expect comfort to improve a little each day. Complete recovery can occur 6 to 12 weeks after surgery.

How can I prepare for a transforaminal lumbar interbody fusion?

When you consult with a surgeon about your back pain and how to treat it, it is important to disclose all medications and supplements you are taking. You may need to stop or switch certain medications before surgery. After your consultation, your doctor may order lab work or other tests, such as additional imaging of the lumbar spine. You will receive an outline of pre-operative instructions to begin following right away. Examples of pre-operative actions include stopping smoking, if applicable, and limiting alcohol consumption. The objective of pre-operative and post-operative instructions is to minimize the risk of complications and maximize your body’s ability to heal properly.

What are the risks associated with transforaminal lumbar interbody fusion?

In experienced hands, TLIF is considered a safe, effective procedure. However, all surgery carries potential risks. These are minimized by choosing a highly-trained, board-certified surgeon who routinely performs the transforaminal lumbar interbody fusion procedure. Risks are also minimized by following all pre-operative instructions.

The general complications associated with TLIF surgery include:

  • Infection
  • Blood clots
  • Reaction to anesthesia
  • Persistent nerve pain
  • Failure to fuse
  • Cerebral spinal fluid leak
  • Nerve root injury

If you have questions regarding the risks posed during TLIF surgery, talk to your doctor. Before surgery, you can expect your surgeon to review potential risks, including their likelihood.

Who is the ideal candidate for transforaminal lumbar interbody fusion?

Healthy adults living with chronic low back pain may benefit from the TLIF procedure. This surgery is performed to correct several spinal conditions. Examples include herniated discs, degenerative disc disease, and spondylolisthesis. The procedure removes pressure from the spinal nerves or spinal cord and re-stabilizes the spine to prevent further degeneration of the affected joints.

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