Transforaminal Lumbar Interbody Fusion (TLIF)
What is TLIF?
Spinal fusion is the surgical technique to stabilize the spinal bones or vertebrae, and the disc, or shock absorber, between the vertebrae. The goal of lumbar fusion is to create solid bone between two or more vertebrae. A solid fusion between two vertebrae stops the movement between the bones. This reduces pain from motion and nerve root inflammation.
Who is a good candidate for TLIF?
Lumbar fusion is indicated in patients who have failed conservative treatment and have disabling back and/or leg symptoms. Specific diagnoses include spondylolisthesis, degenerative disc disease, and recurrent herniated disc – all leading to chronic, mechanical back pain.
How TLIF works
Below is an overview of a TLIF procedure, from pre-op to post-op. If TLIF is right for you, you and your doctor will review this information together in greater detail.
As you prepare for fusion, your surgeon will want to know your medical history in order to identify anything that could affect safe conditions for anesthesia and bone healing.
It’s important to pay attention to your nutrition in the weeks leading up to surgery. Diets high in protein, calcium and vitamin D help in the bone healing process. In addition, patients should stop smoking or chewing tobacco four weeks before the surgery and several months after because nicotine impairs bone healing.
Alcohol, caffeine, and herbals can cause bleeding problems and should not be taken one week before and two weeks after surgery.
Also, some medications should not be taken prior to or after the procedure, such as anti-inflammatory medicines like aspirin and ibuprofen. Check with your surgeon for recommendations about these.
Your physician will also discuss the possible risks associated with back surgery. The main concerns include infection, inadequate bone healing, loosening of the screws or cage implant, or persisting pain after surgery from scar tissue. While all of these risks are rare, anyone of them could create a need for future surgery.
Be sure to discuss these risks and any additional concerns you may have with your surgeon.
During the TLIF procedure, the patient lies face down on a bed designed especially for the procedure.
Through an incision on your back, the surgeon begins by accessing the section of the spine that needs to be fused. First, any bone spurs and disc material pressing on the nerve is removed and the opening around the nerve enlarged. Then the surgeon will remove almost the entire disc between the vertebrae to create a clean space for fusion between the bones. If the disc has collapsed from disease, the vertebrae are moved back into normal position.
The surgeon then prepares the area where the disc was removed so that the spinal implant can be placed for support. After measuring the size of the space, the surgeon inserts an implant made of bone or a synthetic material into the disc space. This implant gives critical support to the spine and aids bone fusion. The surgeon then places bone graft or other special material into the space around the implant to stimulate bone growth- which will take several months.
Then, on the back part of the vertebrae, small screws called pedicle screws are inserted into the bone, and connecting rods are inserted into the screws to give the spine extra stability. This holds everything in place as it heals, and allows for more activities after surgery. Over time, the vertebrae will grow together or fuse.
While pain varies a few weeks after surgery, you should expect major soreness in your back for the first several days. If the doctor uses bone from the pelvis for the bone graft, you will also feel soreness in your hip area.
Pain is managed with medication for two to four weeks and rehabilitation begins in the hospital. A physical therapist will help you get out of bed and walk safely around the hospital. The first couple of days after surgery, patients usually need a walker, and a back brace may also be used when moving.
It’s important to keep an eye on the incision. If it becomes red, tender, or if there’s drainage, alert your doctor. Some minor leg numbness or discomfort is common for a few days, but let your doctor know if it is severe or lasts more than 1 or 2 weeks.
During recovery, you will need to limit your activities. Walking will help with healing, but you’ll need to avoid heavy housework. You can use ice packs every 4 to 6 hours to help alleviate muscle soreness for the first couple of weeks. You may resume driving and sexual activity 4 to 6 weeks after surgery, depending on your condition. Generally, around six weeks after surgery you can return to work, but your doctor will help you decide the best time to do that.
It typically takes about 6 months or more for the bone fusion to completely heal. Your doctor will monitor the progress of the fusion healing with X-rays or a scan.
During that time, high-intensity activities like running and heavy lifting will need to be avoided to make recovery as smooth as possible.