Transforaminal lumbar interbody
fusion (TLIF) surgery
A transforaminal lumbar interbody fusion (called
a TLIF) is essentially like an extended PLIF.
It was developed in response to some of the technical
problems with a PLIF procedure. The main difference
between the two spine fusion procedures is that
the TLIF approach to the disc space is expanded
by removing one entire facet joint (whereas a
PLIF is usually done on both sides by only taking
a portion of each of the paired facet joints).
Transforaminal lumbar interbody fusion description
By removing the entire facet joint, visualization
into the disc space is improved and more disc
material can be removed. It should also provide
for less nerve retraction. Because one entire
facet is removed it is only done on one side.
Removing the facet joints on both sides of the
spine would result in too much instability.
With increased visualization and room for dissection
a larger implant and/or bone graft can be used.
Theoretically, this can allow the spine surgeon
to distract the disc space more and realign the
spine better (re-establish the normal lumbar
lordosis).
Although this has some improvements over a PLIF
procedure, the anterior approach in most cases
still provides the best visualization, most surface
area for healing, and the best reduction of any
of the approaches to the disc space. This however
must be weighed against the increased morbidity
(e.g. unwanted aftereffects, postoperative discomfort)
of a second incision.
Probably the biggest determinate in how the
disc space is approached is the spine surgeon's
comfort level with an anterior approach for the
spine fusion surgery. Not all spine surgeons
are comfortable with operating around the great
vessels (aorta and vena cava) or have access
to a skilled vascular surgeon to help them with
the approach. Therefore, choosing one of the
posterior approaches for the spine fusion surgery
is often a more practical solution.
TLIF surgery risks and complications
The principal risk of this type of lower
back surgery is that a solid fusion will not
be obtained (nonunion) and further surgery to
re-fuse the spine may be necessary. Fusion rates
for a TLIF should be as high as 90-95%.
Nonunion rates after a spine fusion surgery
are higher for patients who have had prior surgery,
patients who smoke or are obese, patients who
have multiple level fusion surgery, and for patients
who have been treated with radiation for cancer. Not
all patients who have a nonunion will need to
have another spine fusion procedure. As long
as the joint is stable, and the patient's symptoms
are better, more back surgery is not necessary.
Other than nonunion, the risks of a spinal fusion
surgery include infection or bleeding. These
complications are fairly uncommon (approximately
1% to 3% occurrence). In addition, there is a
risk of achieving a successful fusion, but the
patient's pain does not subside.
By: Peter
F. Ullrich, Jr., MD
September 8, 1999 (Updated January 20, 2004) |
