TLIF is a surgical technique to achieve surgical fusion of two or more spinal levels in the lumbar spine. This has 2 parts. 1st a cage with bone is inserted into the disc space by creating a space near the exiting root, hence the name ‘Transforaminal’. Then pedicle screws (bone screws) are placed in the spinal body above and below to keep everything in place. This may also be combined with laminectomy and decompression depending on the patient.
This used to be done via an open surgery, where there is a single large incision in the center of the spine and then the muscle over the spine is stripped to the side and surgery done. Now a Minimally invasive approach is preferred where multiple small cuts are used and there is no need to strip or cut the muscle over the back.
Indications:
1. Spondylolisthesis:
A condition where there is a slippage of bone over each other thus causing back pain or back and leg pain.
This can be due to weakness in the joints since birth,
Loosening and weakening of joints over time due to age, trauma, and arthritis.
2: Tumours or other conditions which may have destroyed the joint and may cause instability
3. Patients who may be undergoing re-surgery in the lumbar spine may at times be advised TLIF surgery.
What is Minimally Invasive Spine Surgery (MISS)
As the name suggests, surgery done using small incisions and minimal tissues destruction is called MISS.
Traditionally spine surgery involved large cuts with extensive muscle dissection and cutting thus leading to loss of normal anatomy and destruction of normal tissue and muscles.
MISS aims to achieve the same results while minimizing the disruption of normal tissue and anatomy.
Traditional spine surgery needs long incisions and cutting and retracting large muscles to reach the actual area of pathology.
By using tubular dilators and retractors and modern microscopes the same results can be achieved by using small incisions with minimal tissue destruction.
MISS Spinal fusion\TLIF
Some patients may have a condition called spinal listhesis where there is slippage of the vertebral bodies. This may be due to a defect since birth or due to the loosening of joints over time. These patients require stabilization of the bone along with decompression of the nerve roots if needed. MISS is useful here as it significantly reduces the extent of muscle cutting and stripping thus reducing the post-surgery complications and shortening the recovery time.
Bone has been fixed with screws and cage (TLIF)
The size of incisions needed to do the surgery.
The same incisions after healing
Post operation Recovery and complications:
TLIF is a major spinal surgery and patients can take 3-6 wks to go back to a completely normal life.
Most patients can walk the next day of surgery and can be discharged in 2-3 days. MISS surgery patients tend to have faster recovery, less pain, and shorter hospital stay as compared to open surgery patients.
Patients are started on exercises and regular physiotherapy after the surgery. The purpose of this is to strengthen the back muscles and correct posture and other abnormalities which may have developed over time due to pain and poor immobility.
Complications:
Even Though TLIF surgeries are safe and commonly performed, certain complications can always happen.
- Infection is more common in open surgeries and very rare in MISS
- Implants may get mal-positioned and impinge on nerves or become loose which may require repositioning.
- Surgery aims to achieve fusion and bone formation. This may not be adequate in approx 5-10% of patients due to multiple factors
- Incomplete relief or no relief. Spine pain is multifactorial that’s why a selection of the right patient, procedure, and surgeon is very important to achieve a good outcome.
- Weakness in foot or legs: Depending on the level of surgery there is a remote chance that the patient may develop weakness in the foot or leg. But this is very rare
Conclusion:
TLIF or spinal fusion surgery is a safe and effective surgery when done for the right indication. Minimally invasive TLIF can achieve the same results as open surgery with reduced complications and hospital stays.
Patients should talk to their surgeon regarding MIS TLIF or find a surgeon experienced with it.
This is what my 26yr old patient says about the surgery:
I'm 26 years old. I was suffering from spondylolisthesis since the age of 9. The pain was getting worse over the years. This year the pain became too much. I was aware that I needed a surgery from the beginning however never felt okay with surgery, always felt the risk was huge. This year a family friend suggested me meet Dr Anurag Gupta. I met him, he explained to me the pro and cons of the surgery in detail. He was confident about the surgery and explained everything in detail. I was convinced to undergo the surgery. He advised me about the minimally invasive procedure and its benefits. After my surgery, I was walking the next day and was discharged the day after. I went home sitting in a car on the second day of the surgery. I'm able to go for 8-10km walks without pain at all, which was not possible before surgery. Dr. Anurag was supportive throughout and helped me a lot. Once the spinal issues start hampering your day-to-day life always consider surgery. Staying in pain is not worth it. There is minimal risk in these procedures and recovery is quite fast. I would suggest everyone go with what Dr. Anurag suggests. This surgery changed my life and the entire credit goes to Dr Anurag Gupta.
