Is TLIF Necessary?

Spinal diseases are common. Generally, these conditions present with symptoms such as back pain and decreased movements of the back. In some cases, the spine may be damaged or injured for many reasons. TLIF is considered another method to treat spinal diseases.

What is TLIF

TLIF (Transforaminal Lumbar Interbody Fusion) is a procedure designed to eliminate motions in the spinal segments and increase spinal stability by infusion. It is performed by removing an intervertebral disc and joining vertebrae (two or more) together by screws and a cage.

TLIF spine is an invasive method. The procedure usually involves these steps:

• Facet joint removal
  
  
• Intervertebral disc removal
  
  
• Nerve root decompression
  
  
• Disc stabilization by using pedicle screws
  
  
• Spinal fusion (interbody fusion) by using a cage
  
  

When Should You Considering TLIF

Generally, TLIF is recommended in cases where symptoms do not improve with non-surgical treatment. Indications for TLIF spine are as follows:

1. Pseudoarthrosis: the decreased solid fusion due to a previous spinal fusion surgery.
   
   
2. Spondylolisthesis: the condition of a vertebrae slipping over another.
   
   
3. Degenerative disc disease with nerve root compression
   
   
4. Foraminal stenosis.
   
   
5. Discogenic lower back pain.
   
   
6. Recurrent HNP (Herniated Nucleus Pulposus). Usually, this condition will cause severe low back pain with radiating pain into legs. TLIF is used to remove the disc, decrease pressure on the nerve, and re-stabilize the vertebrae.
   
   

TLIF vs PLIF

Before we take a more in-depth step regarding the procedure, let’s learn more about alternative spinal surgery. How is TLIF different from PLIF (Posterior Lumbar Interbody Fusion)?

TLIF vs PLIF

The similarities:

• Both procedures involve bone graft substitution (artificial) or laying down of bone graft (organic) across the specific areas of the spine to stimulate bone growth. The action prevents any motions regarding that segment.
  
  
•  Both procedures involve interbody fusion (fusion of the disc).
  
  

The difference:

The approach to perform interbody fusion:

• PLIF: first performing a laminectomy to remove the bone, pulling the dura-covered nerves to one side, and placing bone graft and a cage directly into the specific area: the disc space.
  
  
• TLIF: removing one of the facet joints and avoiding nerve retraction. This method still takes out the disc and replaces it with bone graft and a cage, but it is safer than PLIF due to less invasion to the related structures.
  
  

However, both procedures, TLIF and PLIF, are still widely performed depending on patients’ conditions. TLIF is more popular than PLIF, but PLIF is more suitable for some cases.

TLIF Procedure

TLIF is considered to be a major surgery. These are steps of TLIF technique:

1. You will be given a general anesthetic. After being asleep, a breathing tube will be inserted. Intravenous antibiotics and steroids injection will be given to you, as well as calf compression devices and a catheter will be used in the surgery.
   
   
2. You will lie on the bed with your face down on the operating table.
   
   
3. Your skin will be cleaned with antiseptic solution and injected with some local anesthetic.
   
   
4. The incision is about 6-10 cm. wide will be made on your skin.
   
   
5. The back muscles will be pulled sideways, exposing the spine. The screws will be inserted into the pedicles at the specific levels.
6. The facet joints will be removed, and in cases of nerve root compression, it will get decompressed.
   
   
7. The removal of nucleus pulposus is performed using a combination of various equipment.
   
   
8. The fusion will be facilitated by bone graft.
   
   
9.  An interbody cage will be filled with bone and inserted into the disc space.
   
   
10. To prevent nerve roots from getting scarred, a small piece of fat will be laid over the structures.
    
    
11. The bone will be laid down over the laminae, the opposite facet, and transverse processes of related areas.
    
    
12. The screws will be connected by rods.
    
    
13. Several x-rays will be performed throughout the procedure to ensure that the operation is going well.
    
    
14. At the end of the TLIF procedure, the surgical field is checked for excessive bleeding or other problems before closing the wounds with dissolving sutures or staples.
    
    

How to Prepare for TLIF

Before getting in the operation room and undergoing TLIF procedure, patients need to prepare themselves for the surgery. Here are steps of TLIF surgery preparation:

1. Taking a thorough physical examination and history-taking with your doctor to ensure that you are ready for the surgery.
   
   
2. Fasting. You have to refrain from eating and drinking prior to undergoing TLIF.
   
   
3. Taking x-ray(s) both before and after the surgery. Several x-rays will be done in the process of the surgery as well.
   
   
4.  The equipment such as a catheter and an IV drip is common. Normally, these will be removed within 24 hours after the surgery.
   
   

TLIF Risks

Any major surgeries come with risks, TLIF is not different. Despite the fact that TLIF is generally safe, some uncommon complications can still occur. People may have minor complications with the prevalence of 4-5%. Most patients experience no complications after TLIF surgery.

Here are some risks regarding the TLIF procedure.

1. Fail to benefit symptoms or to prevent deterioration.
   
   
2. Wound infection.
   
   
3. Worsening of pain/weakness/numbness of the back or the legs.
   
   
4. Blood clot in wound (requiring urgent surgery to relieve pressure).
   
   
5. Cerebrospinal fluid (CSF) leak.
   
   
6. Injury to bowel or abdominal blood vessels when the disc is being removed.
   
   
7. Bladder or bowel incontinence.
   
   

Practices After TLIF

Taking good care of yourself after surgery is important. Here are some suggestions of what you should (or should not) do after undergoing TLIF.

1. Taking medication as prescribed.
   
   
2. Maintain a normal diet. Eating healthy foods is recommended.
   
   
3. Frequent short walks and walking up and down stairs (about 1-2 hours a day) is suggested.
   
   
4. No twisting, or bending your back.
   
   
5. No driving for at least 6-8 weeks after surgery.
   
   
6. Prolonged sitting such as traveling a long trip on the road is not recommended. This includes sitting for more than 20 minutes in normal daily life as well.
   
   
7. No vigorous exercise/playing sports until the doctor says otherwise.
   
   

TLIF FAQ 
Some of TLIF FAQs

Are there long-term limitations due to a TLIF?

Generally, TLIF involves spinal fusion, meaning that you will feel back stiffness at the level of fusion. The amount of stiffness will depend on how many levels of spine get infused.

Is a brace necessary?

A brace may be necessary for some cases to help support the back after surgery.

Can I exercise after TLIF surgery?

You should refrain from exercise for the first several weeks after surgery. The level of activities should gradually increase as the recovery period goes.

TLIF Conclusion

TLIF is a spinal surgery with the purpose of increasing spinal stability and removing protruded discs. The procedure involves spinal fusion (called interbody fusion) and intervertebral disc removal. The surgery is generally safe with low risks of complications. TLIF costs vary depending on healthcare providers. It is recommended that you seek professional advice before undergoing TLIF surgery.