Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF)

Transforaminal lumbar interbody fusion (TLIF) is is an adaptation of a posterior lumbar interbody fusion that is often performed as a minimally-invasive surgical (MIS) procedure. TLIF is used to restore disc height and permanently fuse damaged or displaced vertebrae in the lower back. Conditions such as degenerative disc disease, spinal stenosis, or spondylolisthesis can cause spinal instability and considerable pain. TLIF is used to stabilize the spine by restoring disc height and fusing the vertebrae together and alleviating nerve compression.

During the TLIF procedure, your doctor will have you lie face down on a special surgery frame. This position allows your doctor to operate on the back of your spine. It also lets your abdomen relax, which reduces blood loss during the procedure. General anesthesia is used, meaning you will be asleep during surgery.

Procedure

First, the spine is approached through a three-inch to six-inch long incision in the midline of the back and the left and right back muscles (erector spinae) are stripped off the lamina on both sides and at multiple levels.

After the spine is approached, to perform the PLIF procedure, the lamina is removed (laminectomy) which allows visualization of the nerve roots. The facet joints, which are directly over the nerve roots, are usually undercut to give the nerve roots more room and more room for performing the fusion and/or instrumentation. For the TLIF procedure, the entire facet joint is removed.

The nerve roots are then retracted to one side and the disc space is cleaned of the disc material. Bone graft is then inserted into the disc space with or without interbody cages. For a standard PLIF procedure, the bone graft and/or instrumentation is performed on both sides. For the TLIF procedure, the disc space is accessed from one side, reaching over to remove and replace the disc on the other side.