Transforaminal Lumbar Interbody Fusion (TLIF): Advantages

The Transforaminal Lumbar Interbody Fusion (TLIF) technique is a unilateral (one-sided) technique, which allows the surgeon access to the interbody disc space. The TLIF technique is advantageous over a posterior spinal fusion technique because the surgeon is able to restore intervertebral body height, reduce spondylolisthesis, degenerative instability, and enhance lordosis (natural curvature) by maintaining anterior column height with posterior spinal fixation (e.g. cages, rods, screws). Further, a greater surface area for fusion is obtained, which enhances the potential for a successful fusion. The technique also allows the surgeon to directly address a disease process in the front of the spinal column.

A comparison of the TLIF procedure to an Anterior Lumbar Interbody Fusion (ALIF) technique reveals that a posterior spinal decompression allows the surgeon to directly decompress nerves and reconstruct the spine. Further, posterior decompression exposure allows for the advantages of pedicle fixation to maximize and enhance spinal stability. This can be helpful in deformity correction and rigid fixation.

As with any surgery, there are risks. The risks associated with a posterior surgical technique are primarily nerve-related. These risks are more routine than the vascular risks that are inherent with ALIF.

There are several advantages distinct to the TLIF approach and the unilateral (one-sided) aspect of the surgical technique:

1. Maximizes fusion and spinal stability; the posterior elements are better preserved thereby reducing spinal destabilization.

2. Allows for less nerve retraction during surgery, reduces scarring, and preserves more bony surface for fusion.

3. Better access to the neuroforamen (nerve passageways) and reduces the need to manipulate (move) spinal nerve roots.

4. Nerve injury may be avoided that may occur during retraction (moving a nerve within the surgical field). This type of injury is sometimes seen in PLIF and bilateral posterior interbody fusion techniques.

5. Operative time, blood loss, and risk of damage to nerve structures are reduced.

6. Affords the surgeon a larger working zone within the disc space. The working zone protects the spinal nerves, allows the surgeon to visualize nerve structures, and gain complete access to the disc space. The surgeon then performs the discectomy, prepares the disc space (curettage), restores proper intervertebral disc height, places the implants or instrumentation (e.g. cages, rods, screws), and grafts to facilitate fusion.

7. A unique feature of the TLIF technique is its ability to restore interbody height and proper spinal curvature, which further helps to stabilize the spine and adds to its fusion potential.

8. The surgeon can achieve anywhere between 5-degrees to 10-degrees of lordosis (spinal curvature) per level and can correct deformities resulting from low-grade spondylolisthesis.