MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION (MIS TLIF)
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.
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.
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.
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.