Surgical Information

Transforaminal Lumbar Interbody Fusion (TLIF)

What is transforaminal lumbar interbody fusion?

Transforaminal lumbar interbody fusion (TLIF) is an advanced procedure often used when there is instability in the spine or shifting of the vertebrae from spondylolisthesis. TLIF is performed in an open fashion or minimally invasively, depending on the pathology involved. The procedure involves fusing two vertebrae by placing screws, rods and a cage to stabilize the region. The disc in the front of the spine is removed and replaced with a stabilizing implant containing a bone graft. The two vertebrae are then fused together through the disc space. In select cases, TLIF can be performed in a minimally invasive fashion to cause less disruption of the tissue and allow for faster recovery.


In these front and side views of a TLIF procedure, note the screws in the back of the vertebrae. The cage can only be seen by the white metal markers. Bone graft is in the disk space inside and around the cage.
-Source:AAOS

Who is a good candidate for this procedure?

Potential candidates for TLIF are patients with instability in the lumbar spine from disc degeneration, spondylolisthesis (where one vertebra has slipped forward over another), degenerative scoliosis (spine misalignment) or recurrent herniated disc. However, not everyone is an appropriate candidate for this procedure. A surgeon who is trained in TLIF and other spinal fusion techniques is the best person to determine the most effective surgical option for each patient. A consultation with the proper surgeon is crucial in making that determination.

Anatomy

The lumbar spine, or low back, includes the five largest and strongest vertebrae. Between each vertebra is a gel-filled disc that acts like a shock absorber, providing a cushioning effect to absorb pressure and distribute stress. The lumbar spine is vulnerable to many pain-provoking disorders, ranging from simple strains to a herniated disc, degenerative disc disease, spondylolisthesis or spinal stenosis.

When is surgery recommended?

If you have worsening back or leg pain resulting from spondylolisthesis, disc degeneration, a chronic herniated disc or other spine abnormality that limits your everyday activities, and all non-surgical methods of treatment have failed, you should consider spinal fusion surgery.

The type of fusion surgery you have depends on many factors including your overall health, the location and severity of your problem, and your pain and disability. It is very important that you are carefully screened by a qualified surgeon who is trained in spinal fusion techniques to determine the most appropriate course of action.

What is the recovery time?

Patients are typically in the hospital for two nights after a TLIF operation. Some may need a third night to recover and others, who have had a minimally invasive procedure, are able to go home the next day. Patients are usually walking the day after surgery and have physical therapy while in the hospital to help with walking and stair climbing. Typically, lifting is limited to five pounds for the first two weeks and 25 pounds for the following four weeks. Many patients who have TLIF surgery are able to return to normal activities in as little as six weeks. As with all surgical procedures, however, specific recovery time varies by patient and demand.

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