MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION (MIS TLIF)


Overview

Spinal fusion is a surgical procedure in which two or more vertebrae are joined or fused together. The MIS TLIF approaches the spine from the side of the spinal canal through a slightly lateral incision in the patient’s back. The incision is typically an inch or so. The approach also approaches the spine between the muscles instead of stripping the muscles form bone. This approach greatly reduces the amount of surgical muscle dissection and minimizes the nerve movement required to access the vertebrae, discs, and nerves. The TLIF approach is generally less traumatic to the spine, is safer for the nerves, and allows for minimal access and endoscopic techniques to be used for spinal fusion. This decrease in trauma to the soft tissue structures often leads to decreased blood loss, shorter hospital stay and more rapid recovery.

Lumbar spine fusion may be recommended for disabling low back and leg symptoms that have not improved with non-surgical forms of treatment. Conditions such as spondylolisthesis, degenerative disc disease or recurrent disc herniations are known to produce mechanical pain and may be indications for a spinal fusion. TLIF is designed to eliminate the disc as the source of mechanical back pain. Depending upon the condition, one may be a candidate for minimally invasive TLIF.

Before Surgery

You will need a complete physical exam to be sure you are in good health. A blood test, electrocardiogram (EKG), and chest X-ray need to be performed. Discuss all medications (prescription, over-the-counter, and herbal supplements) you are taking with your health care provider. Some medications need to be continued or stopped the day of surgery.

Medications that thin the blood should be stopped prior to surgery. Your Internist or primary doctor should be consulted prior to changing or discontinuing any medications. Also, stop drinking alcohol 1 week before and 2 weeks after surgery because these activities can cause bleeding problems. An important thing you can do to ensure the success of your spinal surgery is to quit smoking. This includes cigarettes, cigars, pipes, chewing tobacco, and smokeless tobacco. Nicotine prevents bone growth and puts you at higher risk for a failed fusion.

Morning of surgery

  • Shower using antibacterial soap. Dress in freshly washed, loose-fitting clothing.
  • Wear flat-heeled shoes with closed backs.
  • If you have instructions to take regular medication the morning of surgery, do so with small sips of water.
  • Remove make-up, hairpins, contacts, body piercings, nail polish, etc.
  • Leave all valuables and jewelry at home (including wedding bands).
  • Bring a list of medications (prescriptions, over-the-counter, and herbal supplements) with dosages and the times of day usually taken.
  • If you have a cold, fever or some other illness the day before surgery, please call your surgeons office.
  • Bring a list of allergies to medication or foods.

During Surgery

Under general anesthesia, the surgeon makes a posterior incision exposing the back of the spine. The deep surgical approach uses a plane between the muscles to keep damage to a minimum. Next, any structures such as bone spurs are removed from the spine to decompress the nerves. Next, the facet joint is removed to provide a direct access to the disc while minimizing the manipulation of the nerve roots. The surgeon removes most of the disc, taking care not to go too deep. Next, the fusion part of the surgery takes place.

For the fusion, we prepare the empty disc space and then place bone graft ads well as a cage filled with additional bone graft into the disc space. The cage is typically made of metal alloy, carbon fiber or polymer and maintains disc space height while the bone heals. The bone graft over time heals into the patient’s own bone such that the 2 original vertebrae grow into one. The bone used is typically a combination of bone removed from the surgical site mixed with bone from a bone bank.

A posterior-lateral fusion is typically performed as well to increase the chances of fusing the bone together. Additional bone is placed laterally over the transverse processes vertebra. Lastly, the bone graft and vertebrae must be immobilized while the bone graft and bed heals and fuses. The fusion area is often immobilized and held together with metal plates, rods, hooks, screws, or cages. The surgeon closes the incision and you are taken to recovery.

After Surgery

After TLIF spinal fusion surgery, patients are typically released from the hospital the day of surgery. Blood transfusion is rarely required. Physical therapy is begun 2 weeks after surgery, and patients are gradually mobilized. A spinal brace may be used. Patients are discharged to be at limited activity on oral pain medicine and will follow up with the surgeon in several weeks. The surgical dressing may be removed the following morning and the patient may begin to shower. Do not soak the wound until the incision is completely healed (no pools, saunas, tub baths, etc.). Patients can generally return to office work in four to six weeks, or longer if the patient’s occupation is heavier.

Activity level is usually increased as you progress through physical therapy and the fusion begins to heal (confirmed by routine Xrays at follow up). Typically, a patient is approaching Maximum improvement by the time 6-7 months are reached. Some patients require more time than others. Though you may be approaching your functional maximum by 6-7 months, it is important to note that it can take a year or more to for the bone to fuse completely.

Outcome Studies

For patients with disabling back pain and leg pain and appropriate indications, significant benefits can be obtained with a successful spinal fusion. Physical therapy is generally encouraged for a few months following surgery. A reasonable expectation is for pain to be relatively well controlled with occasional over the counter pain medication when performing basic daily activities. Patients will on average attain a 50 pound weight restriction by around 6 months after surgery. It is important to remember these are general averages and that some patients do better and some do worse.
 


ANTERIOR CERVICAL CORPECTOMY

ANTERIOR CERVICAL DISECTOMY AND FUSION

ANTERIOR LUMBAR INTERBODY FUSION

CERVICAL DISC REPLACEMENT

DISCOGRAPHY

INTRAOPERATIVE MONITORING

KYPHOPLASTY

LAMINECTOMY

LATERAL LUMBAR INTERBODY FUSION

LUMBAR CORPECTOMY

LUMBAR DISC MICROSURGERY

LUMBAR DISC REPLACEMENT

LUMBAR TRANSFORAMINAL EPIDURAL STEROID INJECTION

POSTERIOR – LATERAL SPINAL FUSION (PSF)

SI JOINT FUSION

TRANSFORAMINAL LUMBAR INTERBODY FUSION

VERTEBROPLASTY