Interbody fusion means the intervertebral disc is removed and replaced with a bone spacer (metal or plastic may also be used), in this case using a posterior approach. The posterior technique is often favored when one or two spinal levels are being fused in conjunction with a posterior decompression (laminectomy) and instrumentation (use of metal screws/rods). There are two different types of posterior interbody fusion procedures. The traditional PLIF procedure involves placing two small bone graft spacers, with gentle retraction of the spinal nerves and neurologic structures, one graft on each side of the interbody space (right and left). A newer technique, called a TLIF (transforaminal lumbar interbody fusion), involves placing only one bone graft spacer in the middle of the interbody space, without retraction of the spinal nerves.
PLIF and TLIF procedures are commonly performed for a variety of painful spinal conditions, such as spondylolisthesis and degenerative disc disease, among others.
These procedures may be performed using minimally invasive surgical techniques.
What Is A Minimally Invasive TLIF?
Transforaminal lumbar interbody fusion (TLIF) is a form of spine surgery in which the lumbar spine is approached through an incision in the back. The name of the procedure is derived from: transforaminal (through the foramen), lumbar (lower back), interbody (implants or bone graft placed between two vertebral bodies) and fusion (spinal stabilization).
The TLIF is a variation of the posterior lumbar interbody fusion (PLIF), in that it provides 360-degree fusion, avoids anterior access and associated complications, decreases manipulation of neural structures, reduces damage to ligamentous elements, minimizes excessive bone removal, enhances biomechanical stability, and provides early mobilization.
Traditional, open spine surgery involves cutting or stripping the muscles from the spine. But today, a TLIF may be performed using minimally invasive spine surgery, a treatment that involves small incisions and muscle dilation, allowing the surgeon to gently separate the muscles surrounding the spine rather than cutting them. A minimally invasive approach preserves the surrounding muscular and vascular function and minimizes scarring.
The MIS TLIF approaches the spine from the side of the spinal canal through a slightly lateral incision in the patient’s back. The incision is typically an inch or so. The approach also approaches the spine between the muscles instead of stripping the muscles form bone.This approach greatly reduces the amount of surgical muscle dissection and minimizes the nerve movement required to access the vertebrae, discs, and nerves. The TLIF approach is generally less traumatic to the spine, is safer for the nerves, and allows for minimal access and endoscopic techniques to be used for spinal fusion. This decrease in trauma to the soft tissue structures often leads to decreased blood loss, shorter hospital stay and more rapid recovery.
Why Do I Need This Procedure?
Lumbar spine fusion may be recommended for disabling low back and leg symptoms that have not improved with non-surgical forms of treatment. A spinal fusion procedure such as a TLIF may be recommended as a surgical treatment option for patients with a condition causing spinal instability in their lower back, such as degenerative disc disease, spondylolisthesis or spinal stenosis, which has not responded to conservative treatment measures (rest, physical therapy or medication). The symptoms of lumbar spinal instability may include pain, numbness and/or muscle weakness in the low back, hips and legs.
TLIF is designed to eliminate the disc as the source of mechanical back pain. Depending upon the condition, one may be a candidate for minimally invasive TLIF.
How Long Will It Take Me To Recover?
This minimally invasive procedure typically allows many patients to be discharged the day after surgery; however, some patients may require a longer hospital stay. Many patients will notice immediate improvement of some or all of their symptoms; however, other symptoms may improve more gradually.
A positive attitude, reasonable expectations and compliance with your doctor’s post-surgery instructions all may contribute to a satisfactory outcome. Many patients are able to return to their regular activities within several weeks.
To determine whether you are a candidate for minimally invasive surgery, talk to your doctor.
Your surgeon will take a number of factors into consideration before recommending a TLIF, including the condition to be treated, your age, health and lifestyle and your anticipated level of activity following surgery. Please discuss this treatment option thoroughly with your spinal care provider.