Transforaminal Lumbar Interbody Fusion (TLIF) in New Jersey

What Is A Transforaminal Lumbar Interbody Fusion (TLIF)?

The name Transforaminal Lumbar Interbody Fusion (TLIF) refers to the anatomical structures that are addressed by the surgery. TLIF stands for:

• Transforaminal: This refers to the surgical approach across (trans) or diagonal to the spine, through the intervertebral foramen, which are tiny hollow, bony openings that exist between adjacent spinal segments
• Lumbar: This refers to the lower back called the lumbar spine.
• Interbody: This means the area between two adjacent vertebral bones in the spine.
• Fusion: This refers to the process of fusing two vertebral bones together after having placed them in a cage or spacer for cushioning and height.

Transforaminal lumbar interbody fusion (TLIF) is a minimally invasive spine surgery designed to create solid bone and eliminate motion in a spinal segment. It often is recommended to alleviate ongoing pain caused by conditions like:

• Spondylolisthesis
• Degenerative disc disease
• Herniated discs
• Scoliosis
• Spinal stenosis
• Fracture

TLIF surgery fuses the anterior (front) and posterior (back) columns of the spine through a single posterior approach. TLIF surgery requires less movement of the nerve roots, which decreases the chance of nerve injury during surgery. Robotic surgery can be used to aid the surgeon if the anatomy is severely distorted.

After removing the torn or herniated disc and preventing the surrounding lumbar spine bony structures from compressing the spinal cord and nerves, the spine surgery will prevent the patient from experiencing back pain. Having vertebrae fused, when necessary, keeps patients from experiencing further back pain and discomfort.

Why Is TLIF Surgery Done?

Spinal fusion surgery is done when either the disc between the vertebral bones becomes too destroyed, the vertebral bones themselves become too mobile due to ligament laxity, or the vertebral bones become destroyed by trauma, arthritis, or degeneration. By connecting the vertebra of the spine together, the spine becomes more stable and the patient experiences less pain and greater mobility free from pain or discomfort. Spinal fusion surgery can be used to:

• Reconstruct the spine: TLIF can help correct issues with the way the spine is formed, for example, when the vertebral bone spine is abnormally rotated at one level of the spine.
• Correct spine weakness or instability: This is a common side effect of severe arthritis in the spine called spondylosis. Too much motion between two spinal bones, called spondylolisthesis, can make the spine unstable. Depending on the severity, either spondylosis or spondylolisthesis can require a spinal fusion correction.
• Provide stability: After a damaged disc has been removed, spinal fusion can be used to stabilize the spine and maintain the height of the spine with the placement of a spacer within the spinal column.

Overall, the goal of a spinal fusion is to strengthen the spine after it has been weakened due to damage or disease.

What Are the Risks of Transforaminal Lumbar Interbody Fusion?

TLIF is a safe, effective surgery. But with any surgery, there are possible complications, including:

• Infection
• Bleeding
• Blood clots
• Poor wound healing
• Injury to blood vessels or nerves
• Pain at the bone graft site
• Return of symptoms

If patients have concerns about undergoing TLIF surgery, discuss the options with the top neurosurgery or orthopedic spine team at Centers for Neurosurgery, Spine & Orthopedics. CNSO prides itself on taking the time to educate patients on the cause of their back pain and the best treatment plan from beginning to end.

Choosing a Bone Graft

Because the vertebrae will be fused during TLIF surgery, a neurosurgeon or orthopedic spine surgeon considers which type of material to use for securing the fusion. These can include:

Autograft

Autografts are made by the neurosurgeon or orthopedic spine surgeon from the patient’s own bone because they contain bone-growing proteins in the marrow, which will help avoid an allergic reaction. Bone used to create the autograft can be collected during the spine surgery which may come from vertebral bone or from the hip to form an iliac crest bone graft. The neurosurgeon or orthopedic spine surgeon extracts just a minimal superficial layer, of bone so the thickness of the bone is minimally impacted.

Bone Marrow Aspirate (BMA)

Bone marrow aspirate (BMA) is a patient’s living bone marrow collected with a syringe from the hip or vertebra. This procedure is relatively painless compared to an iliac crest graft.

Allograft

An allograft is when the bone comes from an organ donor. It has been sterilized and is sterilely stored by a bone bank. The donor graft has no bone-growing cells.

Each type of bone graft has its advantages and disadvantages. The spine care team at CNSO will talk with patients about the best choice during their TLIF surgery.

What Happens During TLIF Surgery?

Once a patient and their medical spine team have decided that TLIF surgery is the best option, patients may wonder what happens during the procedure.

Spinal fusion surgery restores the normal anatomical alignment of the vertebrae and permanently secures the alignment in the most functional biomechanical position. When an interbody fusion is necessary, a spacer to maintain height is also necessary. This will allow the patient to move with little to no discomfort.

The spine interbody fusion procedure starts with a small incision directly above the area needing repair. Next, the damaged spine vertebra or intervertebral disc that has become problematic and painful is trimmed back or removed. Then, the bones of the spine are restored to their normal anatomical alignment by the placement of a spacer. Next, a bone graft is placed in the necessary spinal column areas to maintain the correct spine height.

To ensure that the bones hold their position and new bone growth takes place, stabilization hardware, such as pedicle screws or a titanium plate, will be added.

Minimally Invasive Surgery Is an Option at CNSO

At CNSO, minimally invasive surgery and other conservative treatments are used before resorting to other surgical measures. Minimally invasive surgery is a safe and effective treatment option for many patients.

After a patient has been diagnosed and completed imaging testing, the spine care team at CNSO will discuss their treatment plan and options. If a minimally invasive procedure is ideal, surgery involves making a small incision to the affected area. Surgical instruments are aligned with the area where the surgery will take place. Using a microscope and precision tools, the neurosurgeon will perform the procedure.

When possible, the spine specialists at CNSO prefer using minimally invasive spine surgery because it is faster, safer, and causes minimal disturbance to the surrounding muscles and tissues. Other benefits include:

• Less scarring of skin and muscle due to the small incision
• Decreased bleeding during surgery
• Limited exposure to radiation
• Lowered risk of infection
• Fewer pain medication requirements during recovery
• Shorter recovery time

In most cases, patients who have minimally invasive spine surgery can go home on the same day they have surgery.

Recovery From TLIF Surgery

After a successful transforaminal lumbar interbody fusion procedure, patients must rest and adhere to the post-surgical instructions from their orthopedic spine doctor. Patients may be told to avoid:

• Bending and twisting
• Lifting anything heavier than 5 pounds.
• Strenuous activity, including yard work and housework
• Smoking or using nicotine products, like vapes, dip, or chew, as it prevents new bone growth and may cause the fusion to fail
• Driving, until after being cleared by the spine specialist
• Drinking alcohol, as it thins the blood and increases the risk of bleeding
  • Patients also should avoid mixing alcohol with pain medicines

To help relieve pain at home and promote healing after TLIF surgery, patients should:

• Ice the incision three to four times per day for 15 to 20 minutes to reduce pain and swelling
• Not sit or lie in one position longer than an hour, unless sleeping, because stiffness can lead to more pain
• Get up and walk five to 10 minutes every three to four hours and gradually increase when able
• If given a brace, wear it at all times, except when sleeping, showering, or icing

Pain can reoccur after surgery. To prevent other back injuries, the spine specialist team at CNSO recommends:

• Using proper lifting techniques
• Displaying good body mechanics and posture while sitting, standing, moving, and sleeping
• Enrolling in an appropriate exercise program
• Implementing an ergonomic work area
• Maintaining a healthy weight and lean body mass
• Having a positive attitude and implementing relaxation techniques
• Eating a healthy diet
• Avoiding smoking

If a patient has any questions about their surgery or treatment plan, CNSO encourages them to reach out to their medical spine team.

Learn More About TLIF Surgery at CNSO

The dedicated surgical and non-surgical team at Centers for Neurosurgery, Spine & Orthopedics understands how spine problems can impact daily life. Patients will receive comprehensive and coordinated care so they can resume a healthy, less painful lifestyle free from disability. Get care from CNSO’s leading, board-certified neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists.

CNSO offers multiple locations throughout northern New Jersey. Patients can contact the spine specialists at CNSO to learn more about their options for transforaminal lumbar interbody fusion.