Lumbar Fusion Surgery—Transforaminal Lumbar Interbody Fusion (TLIF)


 

What are the indications for a TLIF?

A TLIF is a fusion procedure whereby the disc material between the two vertebrae is removed. To fill in the gap, a special interbody spacer filled with bone and BMP material is placed in the disc space. The bony material in the spacer will form mature bone which will fuse the two vertebrae together. A TLIF is indicated in a segment of the spine that contains a spondylolisthesis or a disc that has herniated at least more than once before.  

How is a TLIF surgery performed?

A TLIF, or transforaminal interbody lumbar fusion, is performed under general anesthesia. The incision is made in the midline low back area. The muscle is dissected from the bony elements of the spine exposing the desired area. Usually, a laminectomy or partial laminectomy is done to relieve pressure on the nerves in the spinal canal. Typically, a significant portion of the joint is removed on the side where the spacer will be placed into the disc. After the exposure of the disc area, disc material is removed. A spacer with bony fusion material packed into the spacer will then be inserted into the disc space wedged in between the two vertebrae. Because of the amount of bone removal required for the exposure, the segment to be fused will also be instrumented with a pedicle screw system to provide immediate stabilization of the spine segment. Typically, a posterolateral fusion will accompany a TLIF procedure. The surgical time can vary from 3-6 hours (sometimes longer) depending on the complexity of the case.

 

What is the recovery from a lumbar fusion surgery?

The hospital stay usually varies from 2-5 days depending on the extent of surgery and overall condition of the patient.  Most patients go home with home care help setup such as a visiting nurse and a physical therapist.  Some patients may benefit from a short stay (several weeks) at a rehab facility.  There is usually back discomfort from the incisional area.  The incisional pain usually significantly improves within 6-8 weeks.  The nerve pain (pain involving the buttock and leg, if present) may resolve immediately after the surgery or may persist for a longer period due to inflammation.  In most instances, there is a significant improvement in the nerve pain by 6-8 weeks.  The nerve pain symptoms can continue to improve for up to 1-2 years after the surgery.  Activity recommended for first 2 weeks after surgery is short walks and mainly rest.  Physical therapy guidance is recommended from 2-3 weeks after surgery for 6-8 weeks.  Return to work can vary depending on the extent of surgery, rate of recovery, and physical demands of the job.  For nonphysical job, reasonable timeline to return to work is 3-4 weeks to 3 months whereas more labor intensive work may require to be out of work for up to 3-6 months. 

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