Minimally-Invasive TLIF (Transforaminal Lumbar Interbody Fusion)

 

Overview
This minimally invasive procedure is used to remove a degenerated disc to relieve the compression of nerve roots in the lumbar spine. It is performed through a small incision on the back.

 

 



Preparation
After anesthesia has been administered and the
patient is positioned face down, the surgeon uses a
portable x-ray machine to identify the diseased
vertebral level or levels. Then, the surgeon makes
the smallest possible incision in the skin directly
above the target level.

Accessing the Vertebra
A series of dilators of increasing size are carefully
passed through muscles and soft tissue using the
guidance of the portable x-ray machine. The
surgeon slides a tubular retractor over the dilators
and removes the dilators, creating a working
channel that leaves muscle tissue intact. This
working channel allows the surgeon to access the
target vertebra and painful nerve root in a way that
minimizes incisional pain and scarring of the
muscles.

Disc Removed
The surgeon may use a microscope or endoscope
to direct surgical instruments through the working
channel. First, the surgeon removes bone at the
rear of the vertebrae to create an opening. This
opening will provide a clear route to the
degenerated disc. The surgeon works through this
opening to carefully remove the disc. Some of the
disc wall is left behind to help contain the bone
graft.

Bone Graft Inserted
An implant filled with bone graft is placed in the
empty disc space. This lifts the vertebrae to the
proper height, realigning the vertebral bones and
relieving painful pressure from pinched nerve roots.

Additional Support
The surgeon will also place fusion instrumentation
for additional support, most commonly screws and
rods. In some cases, these may be implanted on
both sides of the spine. Bone graft may also be
placed along the hardware. Over time, the bone
graft will grow through and around the implants,
forming a bone bridge that connects the vertebral
bodies above and below. This solid bone bridge is
called a fusion.

End of Procedure
The instruments are removed, and the incision is
closed and bandaged. Most patients are discharged
from the hospital the following day and can return to
their usual activity level within a few weeks of
surgery. The patient may take pain medication to
relieve incisional pain, but usually this is needed for
less than one to two weeks.