Transforaminal Lumbar Interbody Fusion
The spine is made up of the spinal cord, vertebrae, and discs. These discs are very important for our range of motion and to cushion our bones against damage. As we age, these discs sometimes become warped, harden, or even tear. This can be extremely painful, especially in the lumbar region of the back. Many nerve endings are rooted near those vertebrae and discs. If a disc slips or moves out of place, it can pull on those nerve roots or even damage them. Sometimes things like physical therapy or pain medication isn’t enough, and back surgery is necessary. A transforaminal lumbar interbody fusion or TLIF surgery is a procedure that removes diseased discs and helps fuse the spine together in a way that may help relieve back pain, reduce muscular strain, and regain function.
This surgery is performed by an orthopedic surgeon, usually only after all other forms of treatment have not been effective. Fusion refers to a surgery that is designed to fuse the vertebrae together so that the disc in between is no longer necessary. Fusions do usually lead to a decrease in range of motion, but it can have so many other benefits that outweigh that. This specific procedure fuses the lower vertebrae. A fusion is performed by removing the diseased disc, then placing a bone graft in its place. This can be bone from the patient or from a deceased donor. This will hopefully grow between the two vertebrae and solidify into one mass, creating a stable place where previously a disc had given flexibility. Unfortunately, this can cause more pain if it is done incorrectly or cannot heal properly, but many spinal fusion surgeries are successful at relieving pain.
Transforaminal lumbar interbody fusion is done through the back, so the patient must lie on their front during the procedure. A small incision is made to one side of the spine next to the damaged disc. This incision is usually only about one or two inches long. This surgery is usually done in a minimally invasive manner, so as to avoid deep incisions or loss of blood.
Disc exposure and removal
To get to the diseased disc, some of the surrounding vertebrae will be removed. Facet joints are small areas of the vertebrae that are cut away to expose the disc. These will not be replaced after the surgery. These are usually important for spinal function, but are no longer necessary after fusion is complete. The disc is then visible, and the doctor cuts away as much of the diseased disc as possible. This can be difficult due to the small amount of space left, especially if the disc has herniated, torn, or become hardened.
Grafting and hardware
Once the disc is removed, the vertebrae are adjusted to a normal height. The bone is scraped directly above and below the gap, so that a cage can be placed. A cage is made of metal and bone material, and it is placed directly in the gap where the disc used to be. This cage will hold the surrounding vertebrae apart, and also contains the bone material that will help cement them together. Other bone grafting tissue is placed around the cage and between the two vertebrae, which will help it to heal faster and become stronger. Then, screws, rods, and plates are added to create more stability and keep the vertebrae from sliding or injuring the surrounding nerves. The incision site is then closed with stitches, glue, or surgical staples.
After the actual procedure has been completed, the patient will remain in the hospital for usually three to five days to ensure that there are no serious complications or problems. While at the hospital, the patient will be shown how to care for the incision site and how to move and perform general activities in a limited manner while the bone graft is healing. This is a very important time for healing and must be taken seriously. Most complications or problems after surgery come from a patient ignoring their doctor’s aftercare plan. The patient can then return home. A follow up appointment will be set about two weeks after the surgery. This appointment will usually consist of an x-ray to make sure that the spine is healing, and a checkup on the wound site. Most people can return to minimally active work after three or four weeks if the spine is healing well. After about three months, the patient should be able to do most things without pain or serious concern.
TLIF risks and benefits
All surgeries have risks and benefits, so it is important to talk to your doctor before having surgery to find out what your specific surgery might be like. This specific surgery does have some drawbacks as well as some things that really make it worth it for many patients.
Anesthesia can cause problems or injury, and if the surgery is done incorrectly those can obviously pose some risks. Fortunately, these are uncommon problems. More commonly, people can experience only partial relief or very little relief from their pain. Nerve injury can happen because of the proximity of this procedure to very important nerves. Also, the fusion could be unsuccessful and could cause injury to the spinal cord. These are rare and are mostly able to be corrected if caught in a timely manner.
Many patients do experience relief from back pain, stability in their spine, and more ability to experience everyday life again. Many times, the TLIF surgery specifically is less invasive and can heal faster and tends to be a great option for younger patients. This procedure also avoids directly exposing the spinal cord, which helps protect the patient from nerve damage.
TLIF and you
If you are considering back surgery, make sure to weigh all of your options, as there are many procedures that can accomplish the same goal. Transforaminal lumbar interbody fusion may be what you need to get relief from pain, and recover quickly. Talk to your doctor today!