Minimally-Invasive TLIF (Transforaminal Lumbar Interbody Fusion)
What is Minimally-Invasive TLIF?
Minimally-invasive transforaminal lumbar interbody fusion (TLIF) is a newer fusion technique for the relief of persistent lumbar region, or lower back, pain. TLIF can often be performed using a minimally-invasive method that involves much smaller incisions and faster, more comfortable recovery. Transforaminal refers to crossing the foramen, which is the opening within each of the spinal bones that allows nerve roots to pass through. This approach is chosen because it offers the advantages of placing two grafts at once with a very low risk of nerve damage. Interbody fusion refers to the removal of an interverterbal disc, which is replaced with a bone spacer, and the adjacent vertebrae are fused together.
Minimally-invasive TLIF can be used to treat nerve compression, disc space collapse, spondylothesis and other painful lower back conditions. After obtaining images of the spine with MRI and CT scans, a physician can determine just what type of implant would be best suited to correct the problem.
During a minimally-invasive TLIF procedure, Dr. Lipani will be making two very small incisions at the midline of the back. Special surgical tools can be inserted through these openings. Rather than cutting into the muscle tissue in the area, Dr. Lipani will use a series of dilators to gently ease the muscles apart. This helps to reduce the amount of trauma the body will endure as compared to open methods of surgery, which results in a more rapid recovery.
The Minimally-Invasive TLIF Procedure
The minimally-invasive TLIF procedure is performed under general anesthesia with the patient lying face down on an operating table. The treatment site is cleansed with an antiseptic and the surgeon makes two tiny incisions in the midline of the back near the affected vertebrae. Dilators are used to separate and ease back the muscles. An imaging device will ensure that the precise vertebrae are targeted. Next, the lamina and pars interarticularis are removed to provide a better view of the nerve roots. The injured disc, bone spurs or any other nearby debris are then taken out. This restores room for the nerves that have been compressed, relieving pain and symptoms in the lower back and legs.
To fill the space that has been created, a bone graft or bone morphogenetic proteins are then attached in the open disc area along with any necessary instrumentation to promote stability in the spine. Often, two spacers containing the graft material will be placed, with one positioned on each side of the interbody space. Dr. Lipani carefully inserts the spacers, avoiding the spinal cord and nerves present nearby. In addition, metal rods and screws are attached as needed to hold the spinal bones in place while fusion is occurring.
Bone morphogenetic protein (BMP) is an FDA-approved treatment used in conjunction with spinal fusion surgery to stimulate bone growth within the treated area and achieve optimal results without the need for a bone graft. However, bone grafts taken from another part of the patient’s own body or obtained from donor bone are also highly successful.
Once complete, imaging is used again to confirm the placement of the spacers and instrumentation. Dr. Lipani can then close up the incisions with sutures. The minimally-invasive TLIF surgery may vary in length, generally lasting between three and four hours, depending on the extent of the damage in the spine.
Recovery from a Minimally-Invasive TLIF Procedure
After undergoing a minimally-invasive TLIF procedure, patients will typically remain in the hospital overnight. A physical therapy regimen should be started soon after, as it is beneficial for regaining strength and full mobility. Certain activities may be restricted, including lifting objects, twisting the midsection and bending at the waist. Many patients can return to work two to three weeks following the procedure if their employment does not require strenuous exertion. After three months, patients may be cleared to resume some sports and more rigorous activities, but this will depend on the number of vertebrae fused during the surgery as well as each patient’s individual healing process.
Risks of a Minimally-Invasive TLIF Procedure
While minimally-invasive TLIF is considered a safe procedure, it is still a form of spinal surgery and it therefore carries some risks. While uncommon, the complications it is associated with include infection, bleeding, nerve damage, blood clots, hardware failure and graft failure.