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What You Need To Know About TLIF

tlif

Back pain can indicate more serious conditions regarding the spine. Spinal diseases such as spondylosis, spondylolisthesis, and spinal fracture may benefit from surgery. TLIF is a back surgery with contemporary approach to treat spinal pathologies, for example, nerve root compression or spinal instability.


TLIF is?

A modern technique for doing spinal fusion surgery is called transforaminal lumbar interbody fusion (TLIF). The main technique involves intervertebral disc removal, and the joining of two or more spinal bones (vertebrae) by screws and a cage during this procedure on the lower back.

TLIF spine usually involves these methods:

  1. Spinal fusion. Spine will get fused by inserting a cage and screws into the disc space, which is also known as interbody fusion.
  2. Removal of intervertebral disc.
  3. Removal of facet joint.
  4. Nerve decompression (in case of nerve entrapment).
  5. Spinal stabilization. This method uses pedicle screws to stabilize at the specific disc level.

TLIF is common, and so is PLIF. It is recommended to know about both procedures before making a decision about undergoing surgery.


Differences Between TLIF and PLIF

Some differences you should know: TLIF vs PLIF

TLIF (Transforaminal Lumbar Interbody Fusion)

PLIF (Posterior Lumbar Interbody Fusion)


When is TLIF Necessary?

A TLIF is generally versatile, but not everyone with low back pain or spinal diseases benefits from this approach. A thorough physical examination and professional consultation are needed before undergoing surgery. These are some examples of TLIF indications.


How Should I Prepare for TLIF

TLIF procedure is a major surgery. Patients need to prepare themselves before undergoing surgery. Here are steps of how to prepare yourself for TLIF surgery.

  1. Stop smoking if you are a smoker. (It is suggested that you stop smoking for 12 months after surgery as well. Smoking decelerates recovery rate and impairs healing process.)
  2. Maintain a healthy weight before surgery.
  3. In case you regularly take aspirin, you have to stop taking aspirin or other antiplatelet medications to prevent excess bleeding during or after surgery.
  4. If you are taking warfarin, a hospital admission prior to your surgery is usually arranged to wear off the medications. It takes about 3-4 days before the medication wears off of your body.
  5. Other than the aforementioned suggestions, it is recommended to consult your physician.

TLIF Process

TLIF technique is a little bit complex because it involves spinal fusion and disc removal. However, the TLIF procedure is still considered safe and popular enough to be performed. The steps of TLIF process will be discussed below:

  1. A general anesthetic will be administered to you. After being asleep, instruments such as an ET tube (endotracheal tube) and a catheter will be inserted into your body, preparing you for surgery.
  2. You will be placed on the operating table face-down.
  3. Antiseptic solution will be used to clean your skin. Then you will be injected with some local anesthetic.
  4. The cut will be made on your skin. The incision is generally 6-10 cm. wide.
  5. Muscle retracting will be performed and the spine will get exposed.
  6. The screws will be inserted into the pedicles at the specific levels.
  7. Facet joint removal will be performed, and if there is nerve root compression, it will get decompressed.
  8. The removal of the disc is performed using a combination of various equipment.
  9. The fusion will be facilitated by bone graft.
  10. An interbody cage filled with bone will be inserted into the specific disc space.
  11. A small piece of fat will be laid over the certain areas of the spine to prevent scarring of nerve roots.
  12. The laminae, the opposite facet, and transverse processes will be covered with the bone.
  13. Rods will be used to connect the screws together.
  14. Several x-rays will be performed during surgery, ensuring that the operation is going well and the condition is looking good.

Risks of TLIF 

Despite being a major surgery, TLIF is considered to be a low-risk procedure. Surgery is generally safe with strict protocols to follow. However, some complications may occur following the surgery. The risk of a major complication is approximately 2-3%, while a minor complication 4-5%. Most people have no complications after surgery.

Here are some possible risks of TLIF surgery you may want to consider:

  1. Adjacent segment disease (such as deterioration of the disc above or below)
  2. Chronic back pain (may require further surgery or other treatments)
  3. Failure to fuse (pseudoarthrosis)
  4. Nerve injury (weakness, numbness, pain)
  5. Recurrent nerve compression
  6. Screw and/or cage breakage, movement, or malposition, sometimes requiring further surgery
  7. Paraplegia (paralyzed or weakened legs)
  8. Incontinence (loss of bowel/bladder control)
  9. Injury to bowel or abdominal blood vessels when the disc is being removed
  10. Impotence (loss of erections)

After TLIF Care

TLIF involves interbody fusion, meaning that some specific segments of your spine will get fused. Here are some suggestions and restrictions for you to follow after the TLIF procedure.

Suggestions:

  1. Maintain a healthy diet.
  2. Frequent short walks about 1-2 hours a day.
  3. Walking up and down stairs.
  4. Avoid swimming, spas, or baths until your wound is completely healed.
  5. Being active. Continue doing daily activities but keeping in mind about restrictions.
  6. Regularly check your wound and look out for signs of inflammation or infection.

Restrictions:

  1. No bending from the waist (>90o)
  2. No twisting.
  3. No stretching or reaching items above your head.
  4. No prolonged sitting for more than 20 minutes.
  5. No driving for about 6-8 after surgery.
  6. No vigorous exercises or playing sports until your doctor says otherwise.
  7. Do not lift heavy objects with weights more than 2 kg.

Are There Long-term Limitations Due to a TLIF? 

TLIF involves interbody fusion, meaning that the fusion will prevent spinal joint movement. You will feel some stiffness at the level of the TLIF. The sensations may be apparent for those who have multiple levels of spine infused. A limited spinal movement is long-term.


Do I need to take medications?

Painkillers are generally prescribed by the doctor after surgery to manage pain. Aside from that, you do not have to take other medications.


TLIF Conclusion

TLIF is a contemporary approach to treat spinal pathologies such as nerve root compression or spinal instability. It involves interbody fusion and disc removal. The procedure is fairly safe and low-risk of complications. Some indications for TLIF are spondylolisthesis, spondylosis with nerve entrapment, etc. TLIF is useful in re-stabilizing the spine and nerve decompression. TLIF costs can vary. It is suggested that you consult your doctor about your symptoms and conditions before making a decision regarding surgery.


 


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