Transforaminal Lumbar Interbody Fusion
Frequently Asked Questions
When considering the indications for lumbar spine fusion, low back pain that lasts for more than six months is the most general indication. The indications for fusing the low back occur primarily in situations where there is a large deformity, such as:
mechanical back pain (usually attributed to disc degeneration)
spinal stenosis (narrowing of the spinal canal)
recurrent disc herniations
spinal instability (spondylolisthesis)
X-Rays, Magnetic Resonance Image (MRI) or CT Scan
Myelogram and CT Scan
Physical therapy (exercises and stretching)
Epidural Steroid Injections (ESIs)
Purpose of Procedure
The primary purpose of this procedure is to stabilize the spine by restoring the disc height and fusing the vertebra together using the patient’s own bone or a genetically engineered substance known as Bone Morphogenetic Protein (BMP). TLIF fuses the anterior (front) and posterior (back) columns of the spine through a single posterior approach. The anterior (front) of the spine is stabilized by the bone graft and cage. The posterior (rear) column is locked in place with pedicle screws, rods, and bone graft.
Bone for Fusion
There are currently two primary alternative sources for the bone needed for the spinal fusion. Traditionally, some of the patient’s own bone has been harvested from the iliac crest (hip bone). This technique produces excellent results for the fusion. Earlier in 2003, the FDA approved a genetically engineered bone substitute for use in spinal fusions. Under the brand name, InFUSE, BMP converts stem cells into bone forming cells and stimulates rapid growth of bone at the targeted site. Using BMP eliminates the need for harvesting the patient’s own bone and speeds up the fusion process.
Advantage of TLIF Approach vs. PLIF
TLIF procedure has several theoretical advantages over some other approaches to lumbar fusion:
Bone fusion is enhanced because bone graft is placed both along the gutters of the spine posteriorly but also in the disc space. A cage is inserted into the disc space helping to restore normal height and opening up nerve foramina to take pressure off the nerve roots. A TLIF procedure allows the surgeon to insert bone graft and spacer into the disc space from a unilateral approach laterally without having to forcefully retract the nerve roots as much, which may reduce injury and scarring around the nerve roots when compared to a PLIF procedure.
Who will be involved in procedure?
Surgeon – The orthopedic surgeon that you have been seeing in our office will be your primary surgeon, in charge of your surgery.
Assistant Surgeon – Another orthopedic surgeon, usually from our office, will assist your orthopedic surgeon with the procedure. This is done to minimize the length of time you are under general anesthesia and to provide the necessary assistance with the actual surgical procedure.
Anesthesiologist – The doctor who actually administers and monitors the anesthesia is a critical part of the surgical team. You will normally meet with the Anesthesiologist during your Pre Op appointment at the hospital.
With most spinal surgeries, patients are up and walking within hours after their procedure, although the walking is very limited. It is no longer necessary, or recommended, that you lie in bed for days or weeks after spine surgery. Nurses who are experienced in working with spinal surgery patients will assist you during your first few efforts at getting out of bed and walking.
Your doctor will tell you when it is safe to shower after surgery. He may put you into a back brace to wear for comfort while the fusion is progressing.
The nursing staff at the hospital will show you how to keep the dressing dry and in place to protect the incision while showering. The wound should not be submerged in water (pool or tub) until it has healed and has been cleared by your doctor. The nurse will change the dressing after your shower, and again later if necessary. Your surgical incision will be checked during your first Post Op appointment. However, should your incision become red and tender or drainage occurs, prior to your first scheduled Post Op visit, you should contact our office for instructions.
Risks and Potential Complications
Complications fro Anesthesia
Continued Low Back Pain
Fusion May Not Occur (higher incidence of non-fusion in patients who smoke)
Hardware (i.e. pedicle screws or cages) may break or come loose
Loss of Sexual Function
Return to Routine of Normal Daily Living
It normally takes approximately 3 to 6 months for the fusion to occur. During that time you should avoid strenuous activities that might affect the fusion process. During the rehabilitation process it is important to recondition the muscles with exercise, stretching and aerobic conditioning.
No guarantees can be made as to the success of this procedure.
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