TLIF Surgery: Transforaminal Lumbar Interbody Fusion

Choose the content to read

• TLIF Surgery
• Why TLIF surgery?
• What diseases does TLIF surgery treat?
• What are the symptoms of spinal degeneration?
• What is the diagnosis before TLIF surgery?
• What is the TLIF surgery procedure?
• What is the benefit of TLIF surgery?
• TLIF surgery at MedPark Hospital

TLIF Surgery

TLIF surgery (transforaminal lumbar interbody fusion) is a spinal fusion technique for treating degenerative discs in the lumbar spine that cause lumbar vertebrae to slip out of place, press the nerves, and cause severe lumbar back pain. TLIF surgery involves using the MIS technique to remove the degenerative disc and replace it with a spacer and a bone graft in its place. The two vertebrae are then fused with titanium rods and screws, enabling the lumbar spines to be strong and stable and relieve back pain. TLIF surgery is a minimally invasive procedure offering less pain and a fast recovery. The surgery is regarded as a safe surgical procedure that helps treat lower back pain, shortens the recovery, and allows patients to resume daily activities quickly.

Why TLIF surgery?

In the past, orthopedic surgeons treated severe lower back pain, chronic back pain, herniated discs, or spinal stenosis with surgery using the open laminectomy surgical technique, which involved making a long incision in the middle of the back to remove some muscles and a degenerative disc, leaving a large surgical wound that took a long time to heal, not to mention severe pain post-surgery and a lengthy recovery period.

TLIF surgery uses new surgical technology with a 3D computerized imaging system that allows for clear visualization of internal organs with precision and positioning, reducing the disadvantages of conventional surgery with a very small incision of only 7–10 mm but offering various treatment efficacy, significantly reducing post-operative injuries, shortening recovery time, and helping accelerate normal activities: sitting, standing, walking, lying down, and other daily activities quickly while reducing post-operative complications substantially.

What diseases does TLIF surgery treat?

Transforaminal lumbar interbody fusion (TLIF) is effective in treating the following conditions:

• Spinal stenosis is a condition caused by spinal discs and joints that deteriorate with age or from excessive use. This causes the intervertebral foramen to collapse, narrow, and press on the spinal cord and nerves, resulting in lumbar spine and neck pain, as well as numbness or weakness in the hands, arms, legs, or feet, mostly found in the elderly.
• Spondylolisthesis is a condition mostly caused by the deterioration of the L4 and L5 lumbar vertebral disc, resulting in vertebrae slipping forward out of alignment, causing severe lower back pain, numbness in the innervation of the compressed nerve, and ongoing lower back pain that radiates down the hips and legs.
• Herniated discs are a condition caused by deterioration of the intervertebral disc with age, excessive use, genetics, or being overweight, causing the intervertebral disc between each vertebra to slip out and press on the nerve, resulting in lower back pain, neck pain, hip pain radiating down one or both legs, numbness, and difficulty bending, lifting, or balancing. Chronic herniated discs can result in numbness, muscle weakness, and excretory problems.
• Degenerative disc disease is a condition characterized by degeneration of the lumbar vertebrae caused by aging, excessive use, or hereditary factors, and is commonly found in people aged over 25. Symptoms include lower back pain, intense pain around the waist, or back stiffness, as well as severe lower back pain when sitting, standing, or walking for an extended period.
• Scoliosis is a condition in which the spine deforms or curves to the side in a “S” or “C” shape by more than 10 degrees. Scoliosis is caused by genetics, neurological or muscular disease, or deterioration from overuse, resulting in the body tilting and losing balance, uneven shoulders, and spinal misalignment. The symptoms will become more severe as the body ages.

Other degenerative spine diseases, such as spondylosis, recurrent disc herniation, spinal instability, and pseudarthrosis.

What are the symptoms of spinal degeneration?

• Lumbar pain, severe lumbar pain, or chronic lower back pain
• Lower back pain radiates to the hips and legs.
• Lower back pain on one or both sides at once.
• Severe lower back pain when sitting, standing, or walking for extended periods of time.
• Lower back stiffness and movement difficulty.
• Reduced range of motion, difficulty walking, imbalanced walking, feelings of stumbling and falling.
• Pain in the lumbar or lower back when moving around the body's organs.
• Numbness or weakness in both legs and feet.
• Difficulty walking upstairs or getting into a car; only taking short steps; unable to step.
• Bowel control problems, bladder, and bowel incontinence.

What is the diagnosis before TLIF surgery?

The orthopedist will make a diagnosis before considering transforaminal lumbar interbody fusion (TLIF) to look for signs of spinal stenosis, spondylolisthesis, and degeneration of the lumbar vertebrae that slip and press on the nerves, as follows:

• Medical history: The orthopedist will inquire about your lumbar or lower back pain, including where it hurts, how long it lasts, any organ numbness or weakness, bladder and bowel incontinence, weight loss, and/or associated fever, as well as whether you have ever had cancer.
• CT scan (computed tomography scan) examines the entire spinal structure, including the joints, discs, and spinal muscles. Examine the spinal column, shape, and spinal canal for abnormalities such as deterioration, degenerative disc, compressed nerve, internal injuries, fractures, broken bones, bone deformities, or infection.
• MRI (magnetic resonance imaging) is a 3D examination of the structure of the spine and spinal cord to obtain accurate and clear examination results, including the intervertebral disc, spinal canal, spinal joints, or nerve, to detect spinal abnormalities such as spinal degeneration, herniated disc, or spinal stenosis.

What is the TLIF surgery procedure?

Transforaminal lumbar interbody fusion (TLIF) at MedPark Hospital adheres to the gold standard surgical procedure, prioritizing patient safety and treatment success. The orthopedic surgeon will perform TLIF surgery using an endoscope to extract the degenerative disc and insert a spacer for prompt relief of pressure and back pain while also ensuring the spine and joints are strong, stable, and secure.

Pre-TLIF surgery procedures

• The orthopedist will ask the patient to stop taking certain medications 2 weeks before surgery, including antiplatelet drugs, aspirin, ibuprofen, naproxen, Plavix, and all herbal medicines.
• Individuals taking Warfarin are required to be admitted to the hospital 3–4 days in advance, as the orthopedist will prescribe an alternative short-acting anticoagulant instead.
• To achieve the best surgical outcomes, patients are advised to quit smoking in advance of the surgery and for 12 months after surgery, as smoking can compromise outcomes.

During TLIF surgery procedures

• The orthopedic surgeon will perform TLIF surgery, making only 1-2 small 7–10 mm incisions. A tiny endoscope will be inserted down into the spine to provide a clear visualization of the lumbar anatomy on the screen, maximizing surgical precision and performance. The orthopedic surgeon will remove the degenerative disc by cutting the facet joint on one side of the spine to reveal the location of the degenerative disc or herniated disc pressing on the nerve.
• The orthopedic surgeon will remove the degenerative disc, herniated disc, or spinal bone spurs, then perform interbody fusion by inserting a spacer or prosthetic disc along with a bone graft and/or mixing it with artificial bone in a space. The 2 vertebras are then securely fixed together with titanium rods and screws. The wound is tightly stitched together and closed. The surgery typically takes approximately 1–2 hours.

Post-TLIF surgery procedures

• The orthopedist will prescribe strong painkillers to relieve the pain. Pain and numbness usually fade away over time.
• Patients can sit, stand, walk, and move their bodies for 3-4 hours a day following surgery. Moving the body gradually improves blood circulation and lowers the risk of blood clots in the leg veins.
• The orthopedist will perform a CT scan the next day to ensure the rods and screws are secure.
• The physical therapist will perform physical therapy to aid in the recovery process and teach the patient how to move safely.
• Patients will stay in the hospital for 1-2 nights. The orthopedist will conduct a physical examination to monitor symptoms and evaluate treatment outcomes. If no abnormalities or complications are found, the patients are allowed to go home.

What is TLIF surgery aftercare?

• Pain symptoms will gradually improve in 2-3 weeks following TLIF surgery.
• After surgery, avoid bending or twisting for 2-4 weeks.
• For 1-3 months, avoid vigorous activities, lifting heavy objects, or strenuous exercise to maximize interbody fusion of the bone mass to firmly secure the artificial disc.
• Within 3-6 months, the upper and lower lumbar vertebrae will fuse together, including the area in front of the bone disc and the facet joints.

What is the recovery time for TLIF surgery?

Typically, patients undergoing TLIF surgery take approximately 6–12 weeks to recover, depending on their physical strength, and can resume some light activities, including driving, within 2 weeks.

What is the complication of TLIF surgery?

TLIF is a surgery that could possibly result in complications such as post-operative bleeding, wound infection, blood clots in the leg veins, a cerebrospinal fluid leak, or a torn nerve. However, these complications are rare (8.7%), which is a small percentage when compared to the significant reduction in lower back pain.

What is the success rate of TLIF surgery?

According to the study of individuals treated by TLIF surgery, 85-90% of patients report significantly less pain in the lower back, lumbar spine, hip, and leg, as well as improved physical mobility. After 2 years of surgery, 95% of patients still report high satisfaction with their surgical outcomes.

What is the benefit of TLIF surgery?

• Minimally invasive surgery (MIS): TLIF surgery uses small back incisions with only 1-2 keyhole surgical wounds of 7–10 mm, resulting in less pain and faster recovery.
• Precision: TLIF surgery is performed using an endoscope, which allows the orthopedic surgeon to locate the herniated disc and enables effective and precise treatment of up to 99% of the cases.
• Fast: TLIF surgery takes only 1-2 hours, as opposed to traditional surgery, which takes 3–4 hours.
• Safe: With a very small incision size of only 7–10 mm, TLIF surgery substantially reduces the possibility of infection-related complications.
• Minimal downtime: Patients undergoing TLIF surgery require only 1-2 nights of hospitalization before returning home. Recovery at home will take approximately 3 months before they can resume day-to-day activities. Unlike traditional surgery, which leaves a large incision that takes more than a year to heal.

TLIF surgery at MedPark Hospital

Orthopedic Center at MedPark Hospital, Bangkok, Thailand, is led by a team of proficient orthopedic surgeons specializing in surgery for degenerative discs, herniated discs, spinal stenosis, and other intricate degenerative spinal conditions through TLIF surgery (transforaminal lumbar interbody fusion) using MIS techniques with a small incision, less pain, and a quick recovery. Leveraging AI medical technology improves surgical precision, reduces complications, shortens recovery time, and effectively fixes degenerative discs.

Physical Medicine and Rehabilitation Center at MedPark Hospital is led by a team of rehabilitation physicians and physiotherapists who have experience providing specialized care and assistance to those undergoing spine surgery, aiding in the restoration of physical function after surgery systematically and appropriately for each individual, aiding in the fast recovery of the musculoskeletal and joint systems, and fostering the strength of the bone and muscles of the patient to have good physical health and quality of life, enabling them to resume daily normal activities quickly.