Transforaminal Lumbar Interbody Fusion (TLIF)

Transforaminal lumbar interbody fusion, or TLIF, is a surgical procedure used to fuse together neighboring bones (vertebrae) in your lumbar spine, or lower back. It is based on another type of surgery, called posterior lumbar interbody fusion or PLIF, but has certain potential advantages over that procedure.

Transforaminal Lumbar Interbody Fusion (TLIF) Basics

All lumbar interbody fusion surgeries involve the removal of a cushioning disc from the lumbar section of your spinal column, followed by joining or fusion of the two vertebrae that sit above and below the disc. Fusion is achieved by placing a device called a spacer in between these vertebrae and giving your body the chance to slowly incorporate it, grow new bone material over it and create a longer section of solid bone. The spacer is a cage-like structure made from your own bone, bone from a donor cadaver, plastic or metal. In most cases, your surgeon will pack its interior with extra material, called a bone graft, made from one of these same substances.

During a posterior lumbar interbody fusion, your surgeon will access your spine through the middle of your back. However, during a transforaminal lumber interbody fusion, your surgeon will access your spine from a point between the middle of your back and your side, or directly from your side. When placing the spacer between your vertebrae, he will work transforaminally; in other words, he will access the site of the procedure through a notch in your spinal bone called a foramen, which carries a nerve running from your spinal cord to another part of your body. In addition to the spacer between the targeted vertebrae, your surgeon will place bone grafts across the backs of the vertebrae and secure them with metal plates or rods held in by screws.

Transforaminal Lumbar Interbody Fusion (TLIF) Uses and Benefits

Your doctor may recommend a transforaminal lumbar interbody fusion if you have severe or debilitating lower back pain or instability stemming from spinal disorders such as herniated or torn spinal discs, a slippage of spinal bones called spondylolisthesis, or a weakening of your spinal discs called degenerative disc disease. In addition to the presence of these problems, candidates for the procedure typically have not gained adequate relief from a full course of nonsurgical treatment.

Because TLIF involves the placement of bone grafts in two different locations, it has a high chance of producing effective long-term results. TLIF also has the advantage of allowing your surgeon to perform the two grafts in a single procedure. In addition, when compared to PLIF, the surgery has a reduced chance of producing damage in the nerves emerging from your spinal cord. Like PLIF, the spacer used during the surgery can reduce nerve pressure by restoring the normal overall height of your spinal column. Roughly 80 percent of people who undergo the procedure report positive results.

Transforaminal Lumbar Interbody Fusion (TLIF) Risks

Potential complications of transforaminal lumbar interbody fusion include blood loss severe enough to require a transfusion, infections, damage to a nearby nerve, graft failure, failure of the hardware that holds the grafted material in place, allergic responses to surgical anesthesia, medically dangerous blood clots, strokes, heart attacks and postsurgical pneumonia. The procedure can also fail to relieve your original symptoms, and as a result you may need to undergo additional surgery. Even in successful cases, people who need spinal fusion typically have problems that are too severe for surgery to achieve full symptom relief. Overall, serious complications from the procedure are uncommon. In some cases, your surgeon may be able to perform a minimally-invasive form of TLIF that reduces your risks for complications during and after surgery.

 

References

American Academy of Orthopaedic Surgeons: Posterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion
University of Southern California – USC Center for Spine Surgery: Minimally Invasive Spinal Fusion (MIS PLF & MIS TLIF)