Spinal diseases are generally treated with conservative treatments first. But when the symptoms do not improve, surgery may be considered. TLIF is a contemporary back surgery with the purpose of treating spinal pathologies such as nerve root compression or spinal instability.
TLIF (Transforaminal Lumbar Interbody Fusion)
What is TLIF?
TLIF (Transforaminal Lumbar Interbody Fusion) is a contemporary approach to spinal fusion surgery. It involves disc removal and spinal fusion by using screws and a cage. TLIF spine performs mainly at the certain areas of the spine and is especially specific for:
- Spinal fusion. Fusing the spine together by using a cage filled with the bone. It aims to fill the disc space.
- Spinal stabilization. By inserting the screws both above and below the specific area of the spine, the stability of the spine increases.
- Facet joint removal.
- Intervertebral disc removal.
- Nerve root decompression.
The alternative approach to spinal fusion is PLIF, which is similar to TLIF but still differs.
TLIF Indications
Because not all spinal diseases require TLIF spine, the procedure is indicated for some specific symptoms or conditions. TLIF is considered a major surgery. Thus, patients should consult their doctors before undergoing surgery.
Here are some indications which are suitable for TLIF:
- Spondylolisthesis.
- Discogenic lower back pain.
- Lumbar canal and/or lateral recess stenosis.
- Disc prolapse resulting in nerve root compression.
- Foraminal stenosis.
- Facet joint pain that does not improve with conservative methods.
Benefits of TLIF
TLIF surgery offers some benefits superior to other procedure which are:
- Foraminal height restoration: A TLIF method, as opposed to a conventional posterolateral fusion, enables the restoration of disc height and, as a result, foraminal height, which can aid in neurologic decompression.
- Single position procedure: The TLIF operation is performed by a single posterior approach, which can frequently result in less time in surgery and under anesthesia. This is in contrast to other approaches for spinal fusion surgery, such as ALIF or XLIF, which require two distinct incisions in two different sites.
- Direct neurologic decompression: The TLIF surgery enables full neurologic decompression and direct access to the nerves. The surgeon does not rely on “indirect” decompression to obtain pain relief, unlike techniques like anterior lumbar interbody fusion (ALIF) and extreme lumbar interbody fusion (XLIF).
However, the advantages of TLIF are balanced by a few drawbacks, such as the challenge of preparing the endplates thoroughly for cage insertion or the challenge of restoring lordosis, the natural curve of the spine.
Preparation Before TLIF
In order to undergo the TLIF procedure, you have to properly prepare yourself. Here are some steps of how to prepare yourself for surgery.
- Getting a thorough history-taking and a physical examination, including x-rays.
- Fasting. You have to refrain from eating and drinking before undergoing TLIF surgery.
- If you are taking warfarin or aspirin, you have to stop taking it prior to surgery. Consult your doctor about specific details.
- Stop smoking.
- Keep a healthy weight. If you are overweight, it is recommended that you decrease your weight before surgery.
- Consult your physician about specific conditions you have such as congenital diseases.
During TLIF Procedure
Due to the fact that it involves disc removal and spinal fusion, the TLIF procedure is a little bit complicated. The TLIF treatment is still seen as safe and common enough to be used, nonetheless. Below are the TLIF process steps that will be covered:
- You will be given general anesthesia. Your body will have tools like an ET tube (endotracheal tube) and a catheter placed into it after you have fallen unconscious in order to get you ready for operation.
- You will be positioned face-down on the operation table.
- Your skin will be cleaned by antiseptic solution. Then some local anesthetic will be injected at the site of surgery.
- The incision, which is approximately 6-10 cm. wide, will be made on your skin.
- The doctor will pull the muscles aside and the spine will get exposed.
- The screws will be inserted into the pedicles at certain levels.
- The doctor will remove the facet joint, and if there is nerve entrapment, it will get decompressed.
- A variety of tools are used in conjunction to remove the disc.
- The fusion will be facilitated by bone graft (either organic or artificial).
- The specific disc space will be filled with an interbody cage filled with bone.
- To prevent the scarring of nerve roots, a little piece of fat will be placed over specific parts of the spine.
- The bone will then cover the laminae, the opposite facet, and transverse processes.
- The screws are connected together by rods.
- Several x-rays will be taken throughout the procedure to make sure everything is proceeding according to plan and the patient’s condition is in good shape.
After TLIF Surgery
TLIF is a major surgery, so you need to properly take care of yourself following the surgery. Your body may need some time to recover itself to function again. Here are some instructions after surgery. What you should or should not do are listed as below:
- Stop smoking. Smoking decelerates healing process of the body, so it can result in worse outcome following the surgery.
- Maintain a healthy diet.
- If you are prescribed medications, take them. Do not take medications on your own.
- Keep your wound dry for 12 days after surgery. Look out for signs of inflammation or infection as well.
What you should do to help accelerate recovery period:
- Frequent short walks about 1-2 hours a day.
- Walking up and down stairs.
- Stritch bed rest is NOT required. You can continue doing daily activities as normal, but keep in mind some restrictions or some activities that you should avoid.
What you should NOT do after surgery:
- Twisting your back.
- Carrying heavy objects.
- Driving for a long distance. (Driving is prohibited for at least 6-8 weeks after surgery.)
- Stretching or reaching for items above your head.
- Bending down from your waist.
- Prolonged sitting such as sitting for more than 20 minutes at a time.
- Playing sports and vigorous exercises are prohibited until your doctor says otherwise.
Complications of TLIF
Even though it involves extensive surgery, TLIF is regarded as a low-risk technique. In general, surgery is safe when stringent guidelines are followed. But after the operation, there could be some issues. A serious complication has a risk of 2-3%, but a moderate problem has a chance of 4-5%. Most patients experience no problems following surgery.
Some examples of TLIF complications are:
- Chronic pain (may require further surgery).
- Fail to benefit symptoms or to prevent deterioration.
- Failure to fuse (pseudoarthrosis).
- Adjacent segment disease (deterioration of the disc above or below).
- Paraplegia.
- Recurrent nerve compression.
- Worsening of pain/weakness/numbness.
- Nerve damage: weakness, numbness, pain. (A rare occurrence of less than 1%).
- Screw and/or cage breakage, movement, or malposition. These conditions sometimes require further surgery to repair.
- Bladder or bowel incontinence (loss of control).
- Impotence (loss of erections).
- Infection.
Can I Exercise After TLIF Surgery?
For the first few weeks after surgery, patients are advised to limit their activities. As soon as a patient is able to handle it, they are typically urged to increase their activity level.
Is a Brace Necessary?
In certain circumstances, the surgeon could advise wearing a spinal brace to support the back as it heals.
Conclusion TLIF
A contemporary approach to spinal fusion is called TLIF. The procedure involves disc removal and interbody fusion to treat spinal problems, such as spinal instability or nerve root compression. The technique is generally safe and has a low risk of complications. Some common conditions indicated for TLIF are spondylolisthesis, spondylosis with nerve compression, spinal stenosis, etc. TLIF costs vary depending on healthcare providers and patients’ conditions. It is advised that you seek professional advice about your symptoms and suitable approach.