Transforaminal Lumbar Interbody Fusion

Transforaminal lumbar interbody fusion (TLIF) resembles spinal fusion surgery, treating lower back disc problems. TLIF is a more advanced version of other back surgeries, resulting in a typically shorter recovery time.

At the Desert Institute for Spine Care, we offer TLIF procedures from some of the most experienced professionals in the nation. Together, we can help our patients enjoy life again. 

What Is a TLIF Surgery and How Does It Work?

Of individuals who experience severe back pain from disc herniations, approximately 95% of these cases occur in the lumbar area of the spine. TLIF removes damaged discs in this spinal area, and the remaining gap is closed by placing a bone graft spacer — also known as a cage — in place with rods and screws. This protects the spine’s height and prevents further nerve pinching. As the area heals, the two vertebral bodies of the spine connected through the spacer will fuse with new bone, stopping painful movements and correcting alignment.

TLIF, a minimally invasive technique, involves making small incisions in the back’s midsection. With TLIF, the spine and the problematic disc are accessed from the side, aiming to reduce nerve root retraction and minimize trauma to the main stabilizing muscles along the spine.  Rather than directly approaching the disc, the surgeon accesses it through the spine’s natural opening for the exiting nerves called the foramen, hence the term “transforaminal” lumbar interbody fusion.

What Conditions Can TLIF Treat?

TLIF can treat any spinal condition that involves nerve damage, degenerative disc disease, or painful lumbar disc herniations. DISC can perform TLIF for the following conditions:

  • Sciatica: Sciatica, also known as lumbar radiculopathy, is when someone experiences pain, numbness or tingling due to a compressed sciatic nerve. These symptoms are often felt in the buttocks, back of the thigh, behind the knees or feet. 
  • Degenerative disc disease: Degenerative disc disease is usually a natural part of the spinal aging process, causing intervertebral disc changes that can become severe. This could include a loss of vertebral cushioning, fragmentation or herniation, resulting in nerve compression and inflammation.
  • Spondylosis: Like degenerative disc disease, spondylosis can develop over time. This can happen when the cushioning between the vertebrae loses fluid and wears away, creating bone-on-bone contact, often referred to as spinal osteoarthritis. Some patients feel no pain, while others can develop bone spurs that stabilize the spine. These can eventually grow to put pressure on the spine and its nerves.
  • Scoliosis: When viewed from the side, the natural curve of your spine should have slight inward and outward curves. Healthy spines will look straight from behind. Scoliosis is a condition that describes any sideways curve of the spine, resembling a C or S when viewed from behind. 
  • Spinal stenosis: Spinal stenosis occurs when the spinal canal narrows, putting pressure on the spinal cord and its nerves. Overuse injury, arthritis, herniated discs or scoliosis are all common causes of spinal stenosis. When located in your lower back, this restriction can cause symptoms in your legs and feet. 
  • Spondylolisthesis: Spondylolisthesis is a spinal condition where a disc slips out of place and slides forward over the disc below it. This can happen if the facet joints become weakened, damaged or injured following a stress fracture, arthritis or an infection.
Close Up of L4 Vertebrae

Benefits of TLIF

Many patients opt for TLIF for several reasons, but almost all cannot deny the impressive advantages this procedure can give them. Some of the most prominent benefits of TLIF patients can experience include:

One of the primary reasons patients reach out about TLIF is to find a way to manage their back pain. TLIF is an effective procedure that removes the problematic disc, decompresses the nerves and relieves significant pain. You can also regain feeling back in your legs and feet.

Being a minimally invasive procedure, TLIF allows a faster recovery time compared to traditional open spine surgeries. TLIF only requires a few small incisions to access the compressed nerves, resulting in less muscle trauma and a quicker return to your regular activities.

Damaged spinal discs create a weakened and fragile spine. TLIF restores its stability and helps prevent further degeneration and other future complications.

Nerve compression and spinal damage in the lumbar area of the spine can result in a decreased feeling in the legs and feet. After TLIF, patients can experience improved lower back, legs and feet functioning, regaining their flexibility and mobility. This opens the doors to perform their favorite activities once again.

With consistent back and leg pain, patients may rely on pain and anti-inflammatory medications to be able to function, even if only for a short while. TLIF can help patients experience significant pain relief and an improved quality of life, reducing the need for extra pain medications and their side effects.

Who Is a Candidate for TLIF?

The medical professionals at DISC work closely with patients to ensure they are ideal candidates for TLIF. The first symptom that doctors look for is chronic back pain that has not responded to other non-surgical forms of treatment. Patients who may be eligible for TLIF may also experience:

  • Increased pain while rising, standing or walking
  • Tingling, numbness or a pins-and-needles sensation in the buttocks and lower limbs
  • Lingering pain in waves
  • Increasing postural abnormalities, such as forward or sideways leaning
  • Rheumatoid arthritis or osteoarthritis in the joints

Please keep in mind that TLIF is ideal for patients with conditions that affect one or two discs. Because of the fusion aspect of the procedure, performing TLIF on more than two discs can significantly limit the patient’s mobility and flexibility.

The DISC professionals will meet with you and discuss your condition’s signs, symptoms and concerns to ensure you are a candidate for TLIF.

man holding back in pain

What to Expect From TLIF

Prior to the procedure, you will meet with your surgeon, who will walk you through everything you need to know for the entire process. While every patient’s TLIF journey can look different, here is a generalized look at what you should be aware of before, during and after the procedure.

Before TLIF

When you meet with your surgeon before your TLIF procedure, you will spend time filling out consent and health history forms — mentioning allergies, current medications, previous reactions to anesthesia, past surgeries, family history and more. Be sure to also inform your doctor of your regular supplements and medications and only take those that are preapproved leading up to TLIF. You will likely be asked to stop taking non-steroidal anti-inflammatory medications and blood thinners about a week before.

You must stop smoking and drinking prior to having TLIF and for around a year after. These substances — especially nicotine — can stunt bone fusion. Smoking can also directly affect blood circulation, which can delay healing and increase the risk of infection. Alcohol can thin the blood and influence post-procedural bleeding problems.

You will need to not eat or drink anything after midnight the morning of your procedure. You can take your approved medications with a sip of water. Dress in clean, loose-fitting clothes, and be sure to remove jewelry, hair pins, contacts, nail polish and makeup.

During the Procedure

The patient is put under general anesthesia while lying on an operating table. Once the patient is asleep, they will be carefully positioned on their stomach and supported with pillows so the incision site is accessible. From here, the surgeon can perform the following steps:

  1. Make incisions: The surgeon will make small, vertical incisions off the midline of the back. These incisions are usually only one to two inches in length.
  2. Removing the facet joint and disc: A portion of the facet joint is removed so the spinal canal is decompressed and the problem disc is accessible. The spinal nerve is gently moved to the side so the surgeon can remove the disc nucleus.
  3. Preparing and inserting the bone graft: The space where the disc was removed is now prepared to insert the bone graft. After filing down any necessary bone spurs, the spacer cage is fitted and put into place.
  4. Installing the screws and rods: The surgeon will insert two screws above and below the spacer and connect them with a rod, holding everything in place.
  5. Closing the incisions: The surgical instruments are removed, and the small incisions are closed.

The TLIF procedure can take around one and a half hours when one segment is treated. The patient may be in the operating room for two to two and a half hours, including the preparation and weaning of anesthesia afterward.

TLIF Recovery

Immediately following TLIF, the patient may feel some soreness at the incision site, but they can soon be given pain medication to help manage any discomfort. Once the anesthesia completely wears off, a medical professional can help you begin ambulating around the office. Standing and walking are recommended throughout your recovery to promote blood circulation and prevent clotting as the site heals.

Patients will usually go home the following day and are encouraged to have a loved one stay to help for the next 24 to 48 hours. Total recovery time can take around six to 12 weeks, but the exact time range can vary from patient to patient.

During recovery time, the patient will be given a series of instructions to follow, regarding:

After TLIF, a patient’s back will be tender for a few weeks while the fusion takes place. It is important that they refrain from bending or twisting their back and from picking up anything heavier than five pounds. While the patient should get up and walk around, they should not do any strenuous activities, including housework, yard work, exercise and more. As previously mentioned, do not smoke or use any products containing nicotine, as they may stunt bone fusion. It is important to wear your back brace provided by your surgeon after surgery anytime you walking around.  This brace gives you much needed support and minimizes your physical activity until your spinal bones have healed and fused.

After the first follow-up appointment, the patient can begin driving, but only for short amounts at a time — around 20 minutes. If the trip is longer than 20 minutes, the patient is encouraged to stop and walk around after certain increments. Likewise, avoid sitting or laying in one position for longer than an hour unless sleeping. Surgeons also encourage short five to ten-minute walks every three to four hours.

Patients should ice their incision three to four times a day for 15-20 minutes at a time. Exact wound care instructions can depend on the type of sutures the patient receives. However, every patient is expected to keep up with their own incision care to promote healing and prevent infection. Some clear or pink wound drainage is normal, but watch for an increase in drainage or surrounding redness. 

The patient will be sent home with prescription pain medication following TLIF. This medication should only be taken as prescribed by the surgeon. The patient should stop this medication once they no longer need it. If still experiencing pain, the patient may take acetaminophen but should avoid anti-inflammatory pain relievers without a doctor’s approval.

A patient’s first follow-up appointment will be scheduled two weeks after the procedure. At this appointment — and subsequent appointments — an X-ray will be taken of the procedural site to ensure fusion is taking place. In the meantime, the patient is encouraged to stay on top of wound care and contact their doctor if they notice any signs of infection, including high fever, swelling, nausea, severe pain, dizziness and confusion.

Success Rate of TLIF Surgery

Because of the advanced techniques involved, transforaminal lumbar interbody fusion can have a higher success rate than other interbody fusion methods, specifically posterior lumbar interbody fusion (PLIF). Both of these techniques involve removing a disc and inserting a graft to promote fusion — however, TLIF approaches the same area from the side. This change in direction proposes a lower risk of injury, reduced muscle trauma and less post-operative pain.

Because of the minimally invasive nature of TLIF, patients are more pleased with the overall outcome compared to open surgical techniques.

Potential TLIF Complications

As with every surgery, there are potential risks that every patient should be aware of when considering TLIF. General complications can include bleeding, infection, blood clots or anesthesia reactions. More specifically to TLIF, patients should understand that the:

If proper healing instructions are ignored, the patient’s vertebrae may fail to connect. Smoking is often the leading reason for this complication, as nicotine can prevent bone growth. Unknown underlying complications like osteoporosis can also cause this to happen. If this occurs, the patient may need a follow-up procedure to fix it.

While the hardware inserted in the vertebrae is titanium and sturdy, there is always a possibility of the rods or screws breaking before the bone has completely merged. This can be fixed with another surgery.

In rare cases, the bone graft or titanium cages can migrate from its placed position shortly after surgery. Another surgery will be required to correct the problem.

Any procedure along the spine comes with potential risks involving nerves. Sometimes, the compressed nerve that requires the TLIF may have long-term nerve damage from disc herniation. If this is the case, the nerve will take some time to heal with the  TLIF or other decompression procedures. Other medications can be prescribed to help the post-operative nerve pain as it begins to heal.

As the vertebrae fuse, this can put stress on and lead to degeneration of the disc and vertebral bodies directly above and below the fusion area. There is a small but likely percentage of patients that may develop adjacent disc disease and may need additional surgery in the future.

Why Choose DISC for TLIF Back Surgery?

DISC is an industry leader in minimally invasive spine surgery, and our surgeons have over 50 years of combined patient experience. Since 1998, we have kept up with the most up-to-date technology to give our patients the best possible outcomes.

We understand that every patient experience differs, so we provide a unique approach to every case. When our patients inquire about TLIF or any of our other procedures, we follow this three-step process:

  1. Getting to know our patients: We want to learn more about our patients as people and listen carefully to their stories of how their back pain has affected them. Together, we will discuss outcome goals and search for the proper treatment to get them back to enjoying their favorite activities.
  2. Performing personalized patient mapping (PPM): The next step is a precise, targeted, and personalized diagnostic approach we developed here at DISC to accurately identify a patient’s pain generator and spinal condition.   It involves a comprehensive evaluation of the patient’s medical history, physical examination, and diagnostic imaging and injections to create a precise map of the spinal pain generator.
  3. Providing surgical pain management: In some select patients that have undergone our pain mapping we can isolate the pain generator and avoid a TLIF surgery by offering our ultra-minimally invasive endoscopic spine surgery techniques.  The fusion alternatives are always a first line of surgery intervention.  But of course not all patients are good candidates for this because of the moderate degenerative condition of their spine.
Dr. Abrams consulting male patient Dr. Abrams consulting male patient

Reach out to DISC for a TLIF Consultation Today

At DISC, our professionals constantly support our patients, walking alongside them every step of the way and helping them enjoy life again. We are proud to serve communities across Arizona.

If you or a loved one are interested in TLIF with DISC, reach out to us today for a consultation. We look forward to guiding you on the path to long-term back health.