Beyond causing intermittent or chronic pain, nerve compression acts as one of the most noticeable symptoms of conditions like Spondylolisthesis, Degenerative Disc Disease and disc herniations. With so many people suffering from lower back pain it is important to not only understand the root of this pain and the mechanism through which the pain travels, but perhaps more importantly, the available treatments for these conditions.
For many patients suffering from lower back pain, the procedure known as Transforaminal Lumbar Interbody Fusion (TLIF) can be a possible treatment.
In the following post we will explore the details and step-by-step procedure of the Transforaminal Lumbar Interbody Fusion, as well as how it differs from other Interbody Fusion procedures. We will take a closer look at the spinal conditions treatable by a TLIF and explore both the risks and benefits of this procedure.
A Deeper Look Into the TLIF Procedure
Step 1: The Incision
An incision is made along the midline of the back, the exact location is dependent on which vertebrae are being operated on. Once the incision is made, the middle layer of the muscle and ligaments surrounding the spine are cut to provide access to the lamina.
Step 2: Accessing the nerves and disc
Once the lamina has been exposed, special bone-cutting instrumentation is used to chip away at the lamina to gain access to the nerves below.
With the lamina removed, the surgeon can then remove the disc through a right and/or left access point on the spinal canal. The disc may be partially or wholly removed, clearing the space to allow for a cage or bone graft to be implemented.
Step 3: Implementation of bone graft to secure anterior portion of the spine
A bone graft taken from the patient’s pelvic area is placed in the interbody space, (the space that previously held the disc), as well as in the gutters of the spine.
Placing the bone graft in both these areas is unique to the TLIF procedure and plays a large role in the successful fusion of the vertebrae. As one of the major goals of the TLIF surgery, spinal fusion minimizes the mobility of the fused segment of vertebrae while also providing increased space, and decreasing nerve compression.
Step 4: Implementation of hardware to secure posterior portion of the spine
While the bone graft does provide some stability for the posterior portion of the spine, additional hardware is used to fully secure the segment.
Pedicle screws and rods are attached to the back of vertebra while an interspinous spacer is inserted into the disc space by way of one side of the spinal canal. This surgical hardware not only secures the segment, but also further facilitates the complete fusion of the vertebrae.
Is the TLIF Right for You?
A refinement of the Posterior Interbody Fusion procedure, the TLIF opts to remove the disc from the side rather than from the back. This approach allows for a variety of benefits for both the surgical approach as well as spinal access.
A much less invasive procedure than its posterior counterpart, the TLIF surgery is done through an incision on the midline of the back but enters the spinal canal through the side. Entering the canal through the side minimizes the amount of muscle that is dissected, allowing for less contact and manipulation of nerves, while still providing full access to the vertebrae and disc space.
This minimally invasive procedure also allows for a faster recovery time since there is less muscle to repair and reduced trauma on both the spine and nerves.
Benefits of TLIF Procedure
- Greater chance of bone fusion because bone graft is placed in both interbody space as well as the gutters of the spinal canal.
- Insertion of disc spacer allows the vertebrae to maintain its normal height while still taking pressure off of the nerve roots.
- Lateral approach to spinal canal allows for minimal retraction of nerve roots, thus reducing scarring and injury.
Risks of TLIF Procedure
There are 4 major risks associated with this procedure, however many of them are general risks for any surgery.
- Incomplete Fusion: Although the complete fusion of the vertebrae as a result of the TLIF procedure has a success rate of 89%, there is a chance that the vertebrae will not fuse completely, leading to complications. If complete fusion does not occur, nerves can continue to be irritated and the pain will remain.
- Nerve Damage: In order to access the disc space, all muscle, ligaments and other soft tissue must be moved to the side. This movement includes the nerve roots, which are also pushed to the side during the surgery. If not handled with care, these roots can be damaged, leaving debilitating pain in the lower back and legs. It is for this reason that an experienced neurosurgeon and surgical staff, like those at BASIC Spine, are of the upmost importance for a successful TLIF procedure.
- Anesthesia: Like most spinal surgeries, general anesthesia is used to keep the patient asleep during the operation. If properly monitored, general anesthesia is a very safe practice; however there can be side effects. Side effects include nausea, vomiting, shivering, sore throat, headache, and confusion. More severe side effects include nerve damage, cardiac problems or allergic reactions, however these are rare.
Post-Operative Care for TLIF Procedure
Patients are kept in the hospital for 3-5 days and though rare, a longer stay may be necessary if complications arise. The day after surgery physical rehabilitation will begin, providing the patient with increased mobility. This therapy will continue for several weeks.
In some cases, a patient may be required to wear a spinal brace to immobilize the vertebrae to allow fusion to occur. Typically patients are able to return to work within 4 to 6 weeks, but this is wholly dependent on the advice of the physician as well as the type of work.
The TLIF Procedure is just one of the many spinal fusion procedures BASIC Spine’s neurosurgical staff specializes in, so if you feel that this procedure may be right for you or you would like more information please contact us today.