TLIF (Transforaminal Lumbar Interbody Fusion)
TLIF surgery treats lower back pain. TLIF stands for transforaminal lumbar interbody fusion. Surgeons do TLIF to relieve chronic lower back pain that happens when intervertebral disks put pressure on your spinal nerves. In TLIF, surgeons replace damaged disks with bone grafts. The bone grafts create new bone that helps fuse or join your vertebrae.
Transforaminal lumbar interbody fusion (TLIF) surgery is a type of spinal fusion. It’s one of several types of lumbar interbody fusion surgeries that remove and replace intervertebral disks in your lower back (your lumbar spine).
Intervertebral disks are round disks that separate and cushion your vertebrae (the bones that make up your spine). When your disks wear out or are damaged, they put pressure on your spinal nerves, which can cause chronic lower back pain. During a TLIF, surgeons replace damaged disks with bone grafts. The bone grafts make new bone that joins or fuses your vertebrae.
You may be a candidate for TLIF surgery if you have:
- Degenerative disk disease.
- Spondylolisthesis.
- Spinal conditions like scoliosis.
- Recurring herniated disks.
- Spinal stenosis.
TLIF is a variation of posterior lumbar interbody fusion (PLIF). PLIF is a common treatment for chronic lower back pain that happens when your disks are damaged or worn out. Typically, surgeons recommend TLIF and other lumbar fusion surgeries when pain management, physical therapy or other treatments haven’t eased back issues. Surgeons may do TLIF as open surgery — when surgeons make a single long incision through your skin — or as minimally invasive spine surgery.
Before surgery, your care team will ask questions to confirm you’re a good candidate for the operation. They’ll ask about your medical history, including any earlier back surgeries. Your team may:
- Do blood tests and other tests to check your overall health.
- Ask if you take any prescription or over-the-counter medications or supplements (including herbal ones).
- Encourage you to stop smoking or using tobacco if you use tobacco in any form. Studies show nicotine use makes it hard for your new bone grafts to grow and your surgical wound to heal. It also increases your risk of infection. Your team will recommend smoking cessation programs to help you quit.
- Discuss options for the bone graft material that will replace your damaged disk.
Seven days before TLIF surgery
You should:
- Limit the number of beverages containing alcohol that you drink.
- Stop taking NSAIDs (nonsteroidal anti-inflammatory drugs) and anticoagulant (blood-thinning) drugs.
- Confirm how long you’ll need to stay in the hospital after surgery and plan accordingly.
- Arrange for someone to stay with you for the first day or two after you go home.
The day of TLIF surgery
You should:
- Stop eating or drinking anything eight to 12 hours before your surgery. If you must take certain medications, you can take a sip of water.
- Remember to bring medications for other conditions with you to the hospital.
At the hospital, you’ll meet with your anesthesiologist. They’ll explain the type of anesthesia you’ll receive and what to expect as you recover from anesthesia.
A healthcare provider will take you to the operating room. You’ll need to lie face down (prone) for surgery. Your healthcare team will help you get into position before you receive anesthesia.
During TLIF, your surgeon will:
- Make an incision (cut) in your lower back, a few inches to the side of your spine.
- Separate your back muscles so they can access your spine, using a surgical tool to hold them in place.
- Open your spine canal by removing lamina and a facet joint. (A lamina is a small section of bone that sticks out from your spine. Facet joints are small joints on each side of your spine and vertebrae. Facet joints allow your spine to turn or bend but keep your spine from bending too much.)
- Gently move your spinal nerve aside.
- Shave a thin layer of bone from your vertebrae to make room for your replacement disk and place a plastic ring between your vertebrae.
- Prepare the bone graft material that will become your new disk. Bone graft material is like a thick paste.
- Your surgeon will put the bone graft material into another kind of spacer called a “cage.” The cage holds the bone graft material that will be placed between your vertebrae.
- Place two sets of screws into bone just above and below the affected disk and then place a rod between the screws. The screws and rod help keep your vertebrae stable while bone graft makes new bone.
- Release your back muscles so they can fall into place and close your incision.
In general, TLIF surgery takes two to three hours.
Your care team will move you to a recovery area, where you’ll rest while you wake up from anesthesia. Your recovery room team will regularly check your pulse, breathing and other vital signs and give you medication for pain.
You’ll move to another room in the hospital to continue recovering from your surgery. Your surgical team will check for complications like infections. You may need to spend three to four days in the hospital.
TLIF is one of several types of lumbar interbody fusion surgeries, including PLIF and ALIF (anterior lumbar interbody fusion). Research shows all three types relieve or reduce chronic lower back pain. If you’re considering spine fusion surgery, your neurosurgeon will recommend the surgical choice that’s right for your situation.
Like most surgeries, TLIF complications may include a risk of infection and excessive blood loss. Other potential complications include nerve damage.
It may take up to a year for you to fully recover from TLIF surgery. Your provider will give you detailed instructions on activities you can do and activities you should avoid as you recover.
It could take a full year before your bone graft completely fills in the space and fuses with your vertebrae.
It may be a relief not to have back pain and you may be eager to get back to your daily activities. Try to be patient and give your body time to recover. For example, you can (and should) take short walks every day. But it may be several weeks before you’re able to do things like bend, twist, lift objects or drive without pain. Here’s what you can expect:
For the first two to four weeks, you should avoid:
- Bending at your waist.
- Twisting your torso.
- Lifting anything heavy, even something seemingly as light as a gallon of milk.
- Driving, especially if you’re taking prescription pain medication that may slow your reactions.
At four to six weeks after surgery, you should avoid:
- Driving on your own even after you’ve stopped taking prescription pain medication and your provider says it’s OK for you to drive. You should arrange for someone to be with you because you can have sudden pain that may distract you and put you at risk of causing an accident.
- Bending and twisting.
- Lifting anything that weighs more than 10 pounds.
When should I see my healthcare provider?
You should contact your provider if you have:
- Fever that’s above 103 degrees Fahrenheit (38.9 degrees Celsius).
- Chills.
- Your surgical site looks red or is tender to the touch.
- You have more pain than you expected.
References
- Lee N, Kim KN, Yi S, Ha Y, Shin DA, Yoon DH, Kim KS. Comparison of Outcomes of Anterior, Posterior, and Transforaminal Lumbar Interbody Fusion Surgery at a Single Lumbar Level with Degenerative Spinal Disease. (https://pubmed.ncbi.nlm.nih.gov/28189865/) World Neurosurg. 2017 May; 101:216-226. Accessed 9/12/2024.
- Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF (https://pubmed.ncbi.nlm.nih.gov/27683674/). J Spine Surg. 2015 Dec;1(1):2-18. Accessed 9/12/2024.
- Reid PC, Morr S, Kaiser MG. State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease (https://pubmed.ncbi.nlm.nih.gov/31261133/). J Neurosurg Spine. 2019 Jul 1;31(1):1-14. Accessed 9/12/2024.
- Virk S, Qureshi S, Sandhu H. History of Spinal Fusion: Where We Came from and Where We Are Going. (https://pubmed.ncbi.nlm.nih.gov/32523481/) HSS J. 2020;16(2):137-142. Accessed 9/12/2024.
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