Minimally Invasive TLIF Today’s Procedure, Conveniences, & Technology
Awake Spinal Fusion is a minimally invasive procedure that doesn’t require general anesthesia. Instead of a lengthy hospital stay, you’re up and about in just a few hours.
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Minimally Invasive TLIF: Today’s Procedure, Conveniences, & Technology

By Dr. Alok Sharan
Aug. 10, 2022

Today, minimally invasive spine surgery — also known as transforaminal lumbar interbody fusion (TLIF) — is more affordable and usually more convenient than open surgical procedures for patients dealing with extreme back and lower-back issues.

A TLIF fusion of the spinal vertebra is a surgical procedure to stabilize the vertebrae and the disc between them. By fusing the vertebrae together, surgeons create solid bone between them, preventing movement between them. This unique procedure reduces nerve irritation and pain that impacts many back patients today.

There can be several reasons why you might need a spinal fusion. You may be suffering from spondylolisthesis, degenerative disc disease, or recurring disc herniations.

However, we should note that there are several ways for surgeons to do lumbar fusions. Below, we’ll discuss what Minimally Invasive Surgical TLIF (MIS TLIF) is all about.

The TLIF Technique for Spine Fusion

As its medical terminology suggests, back surgery using MIS TLIF is accomplished at the posterior part of the spine. The spine is implanted with surgical hardware to aid the fusion process. An interbody fusion spacer is inserted into the disc space from one side of the spine, with screws and rods attaching to the back.

First, an incision is made behind the spine. Vertebrae are screwed together with special screws. On one side, the facet joints are removed as nerve roots are simultaneously protected. We enter the disc space and take out the disc material.

Bone graft is placed in the interbody space and along the back of the vertebras. Historically bone graft was taken from the pelvis; no there are many suitable substitutes that are sometimes used. The bone graft heals and forms one long bone with the vertebra above and below.

To keep the disc height, a bone graft spacer or cage is put in the disc space. Vertebrae and discs get additional bone applied in the lateral gutters (sides). Rods attached with screws, with the wound being closed so it can heal.

From a birds-eye viewpoint, TLIF simultaneously fuses the anterior (front) and posterior (back) columns of the spine. Those interbody spacers and bone grafts mentioned above help stabilize the anterior portion of the spine, and the rods, screws and bone grafts enhance the posterior column.

What TLIF Surgery Can Do for Your Back

Here are some of the advantages of TLIF over other lumbar fusion procedures:

  • When non-surgical treatment hasn’t helped disabling low back and leg symptoms, lumbar spine fusion may be recommended. The mechanical pain caused by spondylolisthesis, degenerative disc disease, or recurrent disc herniations may warrant a spinal fusion. Essentially, TLIF gets rid of mechanical back pain by removing the disc.
  • There’s better bone fusion, because the bone graft is put both in the disc space and in the gutters of the spine. A spacer is also inserted into the disc space, which restores the disc’s height and opens up nerve foramina.
  • Your surgeon is able to work with a unilateral approach, inserting a bone graft and spacer into the disc space from a lateral direction without pulling the nerve roots as much. This often times makes for a less painful and scarring experience.

This type of surgery requires medical clearance, just like all lumbar spine fusions. If you smoke, you should stop. Also, patients may need to have blood drawn before surgery depending on the circumstance at hand.

Taking Care of Yourself After TLIF Back Surgery

In most cases, patients stay in the hospital for three to five days after TLIF surgery. You might need a blood transfusion depending on your specific situation. As soon as the surgery is over, patients start physical therapy. You might also need a spinal brace, but again, this depends on your circumstance.

Within several weeks, you’ll follow up with the surgeon to see if limited activity is okay, as well as getting off pain medicine. It usually takes four to six weeks for patients to get back to work, or longer if their work includes heavy moving or lifting.

An effective spinal fusion can help patients with extreme back pain and leg pain, which is why it’s considered so successful given the minimally invasive techniques used by many surgeons today.

“Most patients are usually able to go home 1 – 3 days after surgery. Patients will typically stay longer, approximately 2 – 5 days, if an anterior spinal surgery is also performed,” states a study published by the USC Spine Center (University of Southern California).

Dr. Sharan performs the awake spinal fusion technique.  About 50% of patients are able to go home the same day with this technique.

“Before patients go home, physical therapists and occupational therapists work with patients and instruct them on proper techniques of getting in and out of bed and walking independently. Patients are instructed to avoid bending at the waist, lifting (more than 5 pounds), and twisting in the early postoperative period (first 2 – 4 weeks) to avoid a strain injury.”

The report adds that patients can gradually begin to bend, twist, and lift after 4 – 6 weeks as the pain subsides and the back muscles get stronger.

Cost Effectiveness, Technology, and More

According to a research study in The Spine Journal, the cost effectiveness of surgical techniques within lumbar spine surgeries over the last decade has become a major topic of discussion.

Also, a recent article in Orthopedics This Week paints a clear case-study picture of modern robotics in spine surgery from 2018 to 2022 — namely that technology could increase precision for minimally invasive interbody spine fusions such as TLIF. The past few years have proven that today’s technology has — depending on the circumstance — given surgeons:

  • The ability to often times plan surgery without the absolute necessity of a preoperative CT scan.
  • The luxury of nimble flexibility within a surgeon’s toolset and considered set of options before and during surgery in specific situations.
  • The ability to watch screws being placed (using a monitor) and know precisely how compliant their placements were in accordance with their pre-operation plan.
  • Higher confidence that spine surgery cases are even more error-free.

Awake Spinal Fusion can answer all your questions regarding surgical versus non-surgical options so you can make an informed decision about treating your chronic low-back pain. Empower yourself with the right information and advice to do what’s right for your spine.