In several posts I am explaining the different techniques that exist to perform the fixation of a lumbar segment. To this fixation between two vertebrae we call it arthrodesis. Today we talk about transforaminal lumbar intersomatic arthrodesis. It is known by the name of TLIF by the acronym “transforaminal lumbar interbody fusion”. We speak of intersomatic because it is intended to perform fusion at the level of vertebral bodies. Transforaminal refers to the approach that passes through the foramen. The foramen is where the nerve root comes from. In the same surgical gesture, this space is extended through which the root emerges.
To understand the technique well I recommend reading the post in which I try the PLIF technique that has some elements in common with the TLIF that we are going to try today.
How is the TLIF technique performed?
The surgery begins by knocking the patient face down, very similar to what we explained in the PLIF technique. Once the incision is made, the paravertebral musculature is removed to access the vertebrae. This involves separating the muscle from the bone and involves an aggression that affects the recovery as we will see later.
The entryway is posterolateral. It goes a little more side than the back track. In the PLIF technique we entered from behind, we removed the entire sheet that is the bone that is in the posterior area of the vertebra. Once this was done, two implants were placed between the two vertebral bodies, accessing one on each side. In the TLIF however, we will only enter on one side. It also acts on the lamina and the pedicle but much less than in the PLIF technique.
Once the surgeon accesses the disc, the disc is removed and a box is placed along with a graft between the two vertebral bodies. We can see in the picture above how it is done. The schematic is a side view. If you look at the photo below, we see the same picture but seeing it from above.
Along with the box is bone grafting. This allows both vertebrae to merge over time.
Just as we did with the PLIF technique, everything is held in place by placing pedicular screws in the vertebra above and below. Then two bars (one on each side) are attached to the screws to immobilize the operated segment. Graft is also added in this area to give greater chances of getting arthrodesis. We can see it in the initial photo of the post.
Advantages of transforaminal lumbar interbody fusion (TLIF)
Transforaminal access has some advantages. On the one hand, it avoids the vascular complications that can occur in the anterior route. It is also less invasive than the PLIF technique and therefore has fewer neurological complications than this pathway.
Disadvantages of the TLIF technique
The disadvantage of TLIF is the aggression to the posterior musculature. We were talking about something similar when talking about the PLIF technique. The lesion of the extensor paravertebral musculature can cause greater postoperative pain, prolong the rehabilitation times and have a worse functional result.
Not only does it damage the muscle itself and the insertions in the bone in the intervention. Sometimes the nerve branches that carry the signal to these muscles are also damaged. This contributes to the loss of muscle capacities that should stabilize the lumbar spine. It depends on the degree of damage caused, but logically limits the chances of fully recovering this musculature.