TLIF: Transforaminal Lumbar Interbody Fusion

If you are suffering from persistent lower back pain, consider consulting Dr. John Lipani for TLIF Surgery! Dr. Lipani can explain the benefits of this advanced procedure and whether you are a candidate. Call (609) 890-3400 today to reach our Hamilton, NJ office. Our practice looks forward to serving you!

What is Transforaminal Lumbar Interbody Fusion (TLIF)?

Transforaminal lumbar interbody Fusion (TLIF) is a newer fusion technique for the relief of persistent lumbar region, or lower back, pain. TLIF is performed from the side of the back rather than the midline. 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 intervertebral disc, which is replaced with a bone spacer, and the adjacent vertebrae are fused together.

What does TLIF Treat?

TLIF can be used to treat nerve compression, disc space collapse, spondylolisthesis, 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.

illustration that is the back of a woman showing her spine in bright white illuminated


This surgery is very similar to posterior lumbar interbody fusion (PLIF). They vary in that during TLIF, it is standard to remove the pars interarticularis of the vertebrae. The pars interarticularis is the portion of the bone between the lamina and the pedicle. Removing it in addition to the lamina creates a larger space in which to place the bone graft without putting pressure on the nerve roots. Since the site is only being accessed by one area, complications are generally fewer and recovery is faster and easier than with other fusion procedures.

Read what our patients are saying!

"Dr. Lipani is the finest neurosurgeon! Compassionate, Caring, Down to Earth with his professionalism; he is the best! My son Alan, had an L-4/ L/5 Spine Fusion, 7.5 hour surgery and I can not thank the “Great Doctor”/Surgeon for his dedication, kindness and caring."

- Alan B.

"The Doctor outstanding in every way possible. Explaining every detail and taking his time to do so. Amazing for a surgeon to be so informing of the procedure to me and my wife. After the surgery he came out and explained everything to me. My wife is doing great after the cervical spine fusion, moving her arm in ways she hasn’t in years and getting her feeling back in her fingers"

- Anthony R.

"Dr. Lipani and his staff are excellent. Dr. Lipani was very thorough. He explained what needed to be treated and why. He has terrific bedside manners. He answered all my questions patiently. Did not rush me at any time. I recommended him to one of my friends and she was extremely happy with him too."

- Poornima S.

How can I prepare for the XLIF procedure?

Before confirming the XLIF procedure, the doctor performs a thorough health examination and medical history review. It is essential to confirm a patient’s good health before performing surgery of any kind. Either our office or your general health provider may perform a chest x-ray, electrocardiogram (EKG), and blood work. Your doctor will need to know all of the medications you are taking, including prescriptions, over-the-counter products, and supplements. Medications that thin the blood increase bleeding risks and may need to be switched or stopped two weeks before surgery.

Another way to prepare for the XLIF procedure is to get your home ready. This is where you will be recovering so it is necessary to ensure that your most-used items are situated between the level of your hips and shoulders. You should not have to bend nor reach to get the things you need. It may be necessary to move some furniture or remove rugs for a short time to eliminate trip hazards. The shower or tub should be treated with non-slip strips, or you might wear non-slip shower shoes to prevent accidents. You may also need to place temporary grab bars in the toilet or tub area so you can get up, down, in, and out easily and safely.

The most important thing you can do to ensure the success of your spinal surgery is quit smoking. All forms of tobacco should be strictly avoided so the body’s circulation can improve. Circulation is an integral aspect of the healing process. Nicotine must also be avoided. This substance, present in cigarettes, gum, as a vape product, and in some smoking cessation pills, inhibits bone growth and presents a risk of fusion failure. Statistics indicate that approximately 40% of patients who did not alter smoking habits experienced fusion failure, compared to only 8% of non-smokers.

The TLIF Procedure

The 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 Dr. Lipani makes a 3-6 inch incision in the side of the back near the affected area. Tools are used to separate and retract 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 plates, 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 a donor’s 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 incision with sutures or surgical staples. The TLIF surgery may vary in length, generally lasting between three and six hours, depending on the extent of the damage in the spine.

What must be removed in order for an interbody fusion to take place?

Once the doctor gains direct access to the spine through small incisions, they remove the intervertebral disc using a special instrument. The natural, deteriorated disc is replaced with a spacer that is measured at just the right height to allow both proper spinal alignment and nerve pathways. The only structure that is removed is the disc.

How big is the incision for spinal fusion surgery?

As a minimally invasive spinal surgery, the XLIF procedure offers the benefits of very small incisions. While some surgeons’ techniques may differ, the XLIF generally involves a few very short or keyhole incisions in the side and back. Dr. Lipani can discuss incisions and other details about surgery during your consultation.

Is the procedure painful?

No. The minimally invasive spinal surgery is performed with general anesthesia. Patients are monitored the entire time by an anesthesiologist. An IOM technician may also be present, continually observing nerve function throughout the procedure. Under general anesthesia, patients are not conscious. The pain receptors in the brain are essentially blocked and do not receive neurotransmissions from the body. After surgery, patients may take prescription pain medication for a short time to alleviate the most intense pain. Keep in mind that XLIF is a minimally invasive spine surgery and, as such, carries less post-operative pain than traditional surgical techniques.

What is recovery like after TLIF Surgery?

After undergoing a TLIF procedure, patients will typically remain in the hospital for three to five days. 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 job does not require strenuous exertion. After three months, patients may be cleared to resume some sports and more rigorous activities. This will depend on the number of vertebrae fused during the surgery as well as each patient’s individual healing process.

What can I do to improve my recovery?

The recovery period after the XLIF procedure is quite short compared to standard surgery. Six weeks as opposed to six months. The best way to promote optimal healing is to follow post-operative care instructions to a tee. Patients should avoid smoking as well as products that contain nicotine. Alcohol consumption should also be avoided. The doctor provides some guidance regarding what activities are beneficial and which should be postponed until the spine has healed completely. Strenuous exercise is an example of an activity to avoid until you have received clearance from the doctor. After surgery, it is necessary to find the right balance between rest and light movement. Walking may be encouraged with the caveat that is it critical to listen to the body. When tired, rest or sleep. Walk and perform physical therapy as you can. The bottom line here is not to push yourself to do too much. Your sole priority after the XLIF procedure is to support your healing spine.

Risks Associated with TLIF

While 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. All of the risks involved with this procedure will be discussed during your consultation with Dr. Lipani.

Will TLIF lower back surgery affect my lifestyle?

Statistics indicate that the XLIF procedure has a very high success rate. Between 85 and 95% of patients obtain significant relief from the pain caused by nerve compression. Post-operatively, patients are able to resume normal activities much sooner after this minimally invasive spine surgery than they would after traditional spine surgery. After about six weeks of recovery and rehabilitation, a good deal of normal function and flexion should be noticed. More than 400 peer-reviewed, XLIF-specific research papers serve as clinical evidence of the benefits that are possible with this procedure.

Schedule A Consultation For TLIF Lower Back Surgery in NJ Today

If you are interested in learning more about TLIF, Contact our New Jersey office at (609) 890-3400 to schedule a consultation with Dr. John Lipani. You can also fill out the form in our contact page, and our staff will help you set up your appointment.

If you would like more information about our services or to schedule an appointment, feel free to fill out our convenient contact form or call us directly at (609) 890-3400.

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