What is a Transforaminal Lumbar Interbody Fusion?

Transforaminal lumbar interbody fusion, or TLIF, is a type of back surgery. It is used to fuse together individual bones of the spine, known as vertebrae, which might be causing pain. Usually the pain results from wear and tear damaging a cushioning disc between two vertebrae. This means the vertebrae are no longer protected from one another during movement, and part of the disc might also stick out and press on a nerve, giving rise to shooting pains. TLIF surgery treats the source of the back pain by removing the damaged disc, as well as fusing the surrounding bones so they no longer move relative to one another.

The transforaminal lumbar interbody fusion technique is carried out in the lumbar region of the spine, commonly known as the lower back. A number of conditions can give rise to severe pain in the lower back, including a slipped, or herniated, disc, and spondylolisthesis, where a vertebra slips forward over the one beneath. Transforaminal lumbar interbody fusion is usually reserved for people who have had back pain for some time and have not been helped by other, non-surgical treatments such as physiotherapy and medication.

Two different types of surgery may be used to perform a transforaminal lumbar interbody fusion. The traditional open surgery method involves making a larger incision in the skin to expose parts of the spine, while the minimally invasive, or keyhole surgery, technique can be carried out through smaller cuts. Using the minimally invasive procedure has advantages of causing less blood loss, reducing pain after surgery, and speeding up recovery so patients can return home earlier.

During the transforaminal lumbar interbody fusion operation, the surgeon takes pieces of bone from the pelvis to create what are known as bone grafts. After removing the damaged disc from between the vertebral bones and leaving a space, some of the bone graft substance is inserted, together with two spacer devices called fusion cages. Fusion cages are hollow constructions made out of carbon fiber, titanium or bone, and they are filled with graft material. Further amounts of bone graft tissue are added around the back and sides of the vertebrae before the surgeon fixes them tightly together using a system of rods and screws. This presses the bones together and helps spinal fusion occur.

Following lumbar fusion surgery patients may need to remain in the hospital for up to a week. After around three weeks of rest, activities such as walking may be resumed, but more strenuous exercise is only possible after several months. Although transforaminal lumbar interbody fusion does not usually remove pain and symptoms completely, most patients feel better after the procedure and are satisfied with the outcome.