Quick Facts
Possible Symptoms
- Leg pain, numbness, and/or weakness
- Back pain, especially with movement
- Bowel or bladder incontinence
Typical X-Ray Findings
- Spondylolisthesis, or slippage of one vertebral body upon another (MRI, CT myelogram).
- Disc and endplate changes suggesting excess “wear and tear” (MRI, CT myelogram).
- Excess movement of one vertebral body upon another when bending forward or backward (Flexion and extension x-rays)
Average Procedure Time
- 3.5 hours
Average Recovery Time
- Home in 2-4 days
- Off work 6-8 weeks, depending on duties
Postperative Limitations
- No bending, twisting, lifting, or strenuous exercises (8 weeks)
- No driving while on narcotics
The Procedure
In an Transforaminal Lumbar Interbody Fusion (TLIF), an interbody cage is inserted between vertebral bodies through the neural foramen, or the space through which the nerve exits the spinal column. The approach for a TLIF is always posterior, or from the back.
During a TLIF, a part of the vertebra called the facet is completely removed on either the right or the left side, depending upon the side of the most pain or nerve root compression. Specialized shavers are used to remove a large part of the disk. After this, a bulleted cage is inserted. I use cages that can be inserted into the disk space and then rotated to fit snugly between the vertebral bodies.
TLIF cages are smaller than ALIF or XLIF cages because they must be inserted through a smaller space. Because of this, TLIFs are almost always “backed up” by a posterolateral lumbar fusion and minimally invasive instrumentation with screws and rods that are placed through the same posterior lumbar incision.
The principal advantage of a TLIF is that it allows for placement of a cage with minimal retraction of the nerve roots, and from a posterior approach with absolutely no abdominal exposure. A disadvantage is that the cage size is limited due to the relatively smaller space through which a TLIF cage must be inserted, which can correlate with lower fusion rates, particularly in higher risk patients such as smokers diabetics, or patients with osteoporosis.