OPEN TRANSFORAMINAL LUMBAR INTERBODY FUSION, POSTERIOR APPROACH
WHAT IS IT?
Transforaminal lumbar interbody fusion is a surgical procedure performed to treat spinal instability by uniting bones of the lumbar region to re-stabilize the spine. Spinal instability can be defined as the deterioration or bulging of vertebra bones causing impingement of the spinal cord, leaving patients with back or leg pain. An interbody spacer placed between the vertebra bones restores and maintains the disc height to stabilize the spine and prevent nerve roots from continual impingement. Bone graft is inserted into the interbody spacer. It is used to fuse the vertebral bones at the level of instability. The material for the bone graft is either transplanted from another part in the patient’s body or acquired from a bone bank. Over a few months, the bone graft and vertebra bones will fuse to become one bone. Finally, posterior instrumentation is implanted to aid in bone fusion. The pathology is approached from the opening called the foramen which is a hole for nerve roots to extend laterally from the spinal canal. In addition, the procedure relieves pressure from a compressed spinal cord and/or spinal nerve roots because herniated disk material removal is part of the procedure.
HOW IS THE PROCEDURE PERFORMED?
The surgeon will use an x-ray machine to identify the diseased vertebral disc space level(s). Then, the surgeon will create a midline incision on the skin at the diseased vertebral disc space level. Dissection and resection of tissue and muscle will be the first in two steps to clear a pathway to the foramen using appropriate receptacles. A laminectomy will be performed to remove the thecal sac and is the second stage in clearing a pathway to the foramen. When the pathology is exposed, a discectomy will be done to remove all disc material at the diseased vertebral level before an interbody spacer is inserted. Bone graft will be inserted between the vertebral bones and posterior instrumentation will be implanted on the vertebra bones for fusion. The incision will be closed in layers with stitches or surgical staples and sterile dressing will be applied.
An open TLIF will require a longer recovery time because a substantial amount of tissue and muscle have to be removed to get to the pathology and is the most invasive relatively to a minimally invasive TLIF and an endoscopic TLIF. Note that the procedure described on this page is for open TLIF from the posterior approach. An anterior approach is also possible if it is the optimal method to treat a pathology.