What is Transforaminal Lumbar Interbody Fusion (TLIF)?
Patients suffering from symptoms due to degenerative lumbar spine disease may benefit from an advanced surgical treatment known as transforaminal lumbar interbody fusion (TLIF). A transforaminal lumbar interbody fusion is a minimally invasive surgical treatment that results in a complete fusion of both the front and back vertebrae also referred to as a 360-degree fusion. Due to the minimally invasive nature it sets up a quick recovery and rehabilitation period for patients. It is recommended in cases when patients are diagnosed with a variety of lumbar conditions including:
- Foraminal collapse where the lumbar disc space has collapsed
- Discogenic pain emanating from:
- A damaged disc nucleus, annuls or nerve root
- Lumbar instability
- Degenerative spondylolisthesis caused by wear and tear
- Isthmic spondylolisthesis caused by a fracture to isthmic
- Herniation of a lumbar disc
The innovation of this procedure improves access to both the front and back of the affected vertebrae through a small posterior incision as opposed to entering the body from both sides of the torso cavity (anterior and posterior incisions). This advancement aids in quicker patient recovery and reduced risk of complication. The goal of TLIF surgery is to decompress the nerves, restore disc space, stabilize the vertebrae and restructure the foramen space. A bone graft is installed such that the biological response results in healthy bone growth between the front and back vertebral elements creating a fusion that halts the motion of the lumbar spinal level and eliminates the cause of the lumbar nerve degenerative disease.
Am I a Candidate for TLIF Surgery?
Dr. Ernest Braxton works closely with patients experiencing lumbar pain to determine candidacy for a transforaminal lumbar interbody fusion. Non-surgical treatments are the first step. Symptoms being addressed non-surgically can be:
- Increased pain when walking
- Lower back pain
- Unusual waves of pain that linger
- A sensation of tingling or pins and needles throughout the body
- Osteoarthritis and rheumatoid arthritis inflammation to joints
- Incontinence and bladder or bowel urgency
- Pain in the buttocks
- Forward leaning and other posture abnormalities that increase
- Pain and difficulty rising and standing
After an adequate period of time treating these symptoms non-surgically with limited results or if symptoms worsen, Dr. Braxton can discuss surgical treatment options. It is optimal if the spinal condition only affects one or two levels of the lumbar spine. Patients with multiple levels of the lumbar spine being affected are not good candidates because spinal fusion between more than two levels results in a great loss of spinal flexibility. Patients with lumbar spine symptoms for less than six months are not considered eligible, nor are patients who have an infection, illness or other factors that impact their overall health.
How is a Transforaminal Lumbar Interbody Fusion Performed?
Dr. Braxton performs the transforaminal lumbar interbody fusion by accessing the lumbar disc space through the foramen, called a transforaminal access. It is a major surgery that requires general anesthesia. The initial incision is made midline of the spine and the affected vertebrae are exposed and the bony structures are treated. The disc is then removed, treated, repaired and restructured such that the disc space is normalized and the bone fusion process is set. The repair is stabilized for optimal fusion genesis and the surgery is ready for completion utilizing screws and rods for extra support during the healing process.
What are the Benefits of TLIF Surgery?
There are several benefits to TLIF surgery including:
- Spinal stabilization due to the fusion
- Repaired nerve eliminating further nerve damage
- Normalizing nerve passageway to relieve neurological symptoms
- Reduction of complications from more invasive surgical procedures
- A greater surgical work zone allowing greater protection to nerves
- Restoration of interbody height and normal spinal curvature
- Amelioration of low degree abnormal curvature from 5 to 10 degrees
Patient recovery and improvement experience are quicker with minimally invasive techniques. There is a quicker return to normal daily activities and up to 90% of patients report being satisfied with surgical results and a decrease in lumbar spine pain and other degenerative spine symptoms. Patients find that it is ok to sleep in their preferred position after the procedure. Use of a pillow between the knees or beneath the legs provides some extra support as needed. Dr. Braxton will provide post-surgical instructions that are intended to facilitate the quickest possible return to preferred activities and lifestyle and a good recovery.
What is the Recovery Like After TLIF Surgery?
The minimally invasive procedure provides many benefits to patients. Hospital stays are commonly between one to three days. Patients report a reduction in pain and other symptoms and can expect a period of improvement over the next several weeks to a month. Post-surgical pain is a good indication of progress as an uptick in pain may indicate doing too much, too soon. It is recommended to slow down when pain increases.
Preventing stress in the fused segments is also recommended and excessive lifting of heavy objects should be avoided. Bending and twisting should also be minimized. A back brace may be useful to help limit back movement and can be helpful from six weeks up to three months. Prescribed stretching exercise can help recovery. A gradual increase in a light walking program promotes mobility. The completion of the bone fusion may take up to a year or more to completely heal. Dr. Braxton monitors patient progress during recovery with an eye on increasing activity level, managing pain levels, return to work considerations and when to return to driving.