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Trans-foraminal lumbar interbody fusion (TLIF)
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Trans-foraminal lumbar interbody fusion is a surgical procedure that involves placing implants (also known as a cage or a spacer) in between lumbar vertebral segments with bone graft to achieve fusion of the vertebrae. This procedure is often referred to simply as “lumbar fusion” or “lumbar stabilization”. In addition to the implant between the vertebral segments, often times the surgeon will need additional hardware (pedicle rods and screws) to further stabilize and optimize for successful fusion. The implant placement between the vertebrae aims to restore proper height in between the verterbral segments and thereby decompress the spinal and foraminal canals. TLIF can be performed through open or minimally invasive approach. Often times when a TLIF is performed through a minimally invasive approach it be referred to as a minimally invasive stabilization (MIS). Whether TLIF is performed through open or minimally invasive approach is determined by a variety of factors. These factors are mostly related to a patient’s condition and the skill of the surgeon.
When to Consider
As with any spine surgery, a TLIF should only be considered when the patient has failed conservative care and symptoms have persisted or worsened. In some cases, based on the severity of the pathology and the associated symptoms, a TLIF may be considered before conservative care is exhausted. Symptoms you may be experiencing that could indicate a TLIF may be necessary: weakness and/or atrophy of the lower extremities, radiating pain, wrapping pain along the belt line, pain that is localized (axial) to the low back, numbness and/or tingling of lower extremities While a trans-foraminal lumbar interbody fusion can be accomplished through a minimally invasive approach, it is vitally important that a patient plan for an appropriate amount of time to recover. Length of time spent in recovery will vary depending on a number of factors and return to work (if necessary) will also vary. While recovery from a minimally invasive procedure will generally involve far less post-operative pain than recovery from an open procedure, with fusion surgery is paramount that a patient pay close attention to post-operative restrictions and guidelines so as not to compromise the outcome of the procedure.
What to expect in surgery
If your conditions can be treated through MIS TLIF it is likely that you can have the procedure done in an outpatient setting. This procedure generally takes between 90-150 minutes. In order to accomplish fusion, bone graft most often is harvested from the patient’s iliac crest (hip bone) and when this is done the graft is considered autograft. In other cases, donor graft may be used and this is called allograft. There are also other synthetic forms of graft that can be used on a case by case basis. Autograft, however, is considered the gold standard in achieving spinal fusion. Hardware (pedicle screws and rods) is often placed during the procedure to act as scaffolding for the fusion to take place. Many patients often end up curious as to how the hardware is placed if the surgeon does not have direct visualization of the spinal anatomy. The answer is through use of intra-operative imaging. During the procedure the surgeon will often use fluoroscopic imaging as guidance for hardware placement. The use of intra-operative imaging and minimally invasive approach for a TLIF procedure results in significantly less trauma to the body, less blood loss during the procedure, and generally less post-operative pain than that of an Open TLIF. Again, while a patient may experience less post-operative pain it cannot be stressed enough to adhere to post-operative guidelines as they exist to ensure a positive outcome from the procedure.