Overview of Transforaminal Lumbar Interbody Fusion (TLIF)

Transforaminal lumbar interbody fusion (TLIF) is a procedure used to insert a bone graft into the spinal disc space from the side position. This surgery is used to treat serious spinal diseases that cause chronic low back pain and radiculopathy.

What conditions are treated using the transforaminal lumbar interbody fusion?

The TLIF procedure is used to treat:

• Degenerative disc disease

• Spondylolisthesis

• Spinal stenosis

• Nerve compression with radiculopathy

What is fusion surgery?

Fusion surgery involves fusing (joining) two or more vertebrae (spinal bones) together. Two types of fusion surgery are transforaminal lumbar interbody fusion and posterior lumbar interbody fusion (PLIF), which involves placing the bone graft between vertebrae from the back (posterior) position. Both PLIF and TLIF involve special spinal instrumentation such as rods, screws, and bone graft substitute material to hold the spine in promotion and promote spinal fusion.

Why is TLIF superior to PLIF?

Some neurosurgeons and orthopedic spine surgeons prefer the TLIF procedure over the PLIF because the nerve roots are not moved as much during the procedure. Entering the spine from the side position means that there is a reduced risk of nerve damage and scarring after surgery.

How is the TLIF surgery done?

The surgeon can perform an open surgery or a minimally invasive keyhole procedure. With the open technique, the surgeon makes a larger incision along the back. Through this incision, the surgeon cuts, retracts, and moves spinal muscles and soft tissue to access the disc space and vertebrae. With the minimally invasive keyhole technique, the surgeon inserts a small tube through the skin that rests on the spine.

Small surgical instruments can be inserted into the tube, so the doctor essentially works to fuse the spine without retracting or cutting muscles. This technique involves a faster recovery time, less blood loss, and a shorter hospital stay.

What outcome can I expect after a transforaminal lumbar interbody fusion?

In a recent clinical study of 50 minimally invasive keyhole transforaminal lumbar interbody fusion procedures, all patients reported immediate improvement with symptoms. The average hospital stay was 2 days, and all patients had significant improvement at the 18-month follow-up evaluation. Another research study found TLIF to be a reliable, safe technique with excellent clinical outcomes.

Resources: Salehi SA, Tawk R, Ganju A, et al. (2004). Transforaminal lumbar interbody fusion: surgical technique and results in 24 patients. Neurosurg, 54(2), 368-374.