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Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF) using Cortical Bone Trajectory Screw Fixation

Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF) using Cortical Bone Trajectory Screw Fixation

A transforaminal lumbar interbody fusion (TLIF) is a surgical procedure that stabilizes the spine and reduces back and leg pain by joining two or more vertebral bones by fusing them with bone forming across the disc space. This minimally invasive technique is used to prevent abnormal movement and allowing for restoration of disc height which then relieves the pressure on the spinal nerves and alleviates leg and back pain without having to open the patient from the front or abdomen and back or a “360” fusion as some of those surgeries are known.

A transforaminal lumbar interbody fusion (TLIF) is a surgical procedure that stabilizes the spine and reduces back and leg pain by joining two or more vertebral bones by fusing them with bone forming across the disc space. This minimally invasive technique is used to prevent abnormal movement and allowing for restoration of disc height which then relieves the pressure on the spinal nerves and alleviates leg and back pain without having to open the patient from the front or abdomen and back or a “360” fusion as some of those surgeries are known.

With this minimally invasive procedure, the entire surgery is done from the back. The final advantage is that by using this new minimally invasive screw placement technique, cortical screw fixation, the surgery can be done with only one small incision not too different in size from a simple surgery for removal of a herniated or degenerated disc.

Who is a candidate for a TLIF with Cortical Screws?

Patients with back pain and leg pain, weakness, or numbness who have failed conservative measures (physical therapy, medication, injections, etc.) and who have evidence of disc degeneration or instability on MRI and for a number of other reasons, including bulging, missing, or compromised discs, narrowing of the spinal canal or spinal stenosis, degenerative disc disease, and spondylolisthesis.

What is a minimally invasive surgical approach?

Minimally invasive spine surgery is performed through a small incision in the back and uses intraoperative X-ray, tubular retractors, and special instruments to avoid extensive damage to the back muscles and sometimes computer or robot guidance.

Minimally invasive surgery has many advantages over traditional (or open) spine surgery that include smaller incisions, less blood loss, smaller scars, a shorter hospital stay, less pain during recovery, and a faster return to work and daily activities.

What is the recovery like?

The patients typically spend 2-3 days in the hospital. The main restrictions are no heavy lifting (no more than 10 lbs. for the first 3 months) and no repetitive bending or twisting at the waist.

Most patients return to light duty or office-type work in 4-6 weeks. Physical therapy is started between 6 and 12 weeks, if necessary.

What follow-up care is necessary?

The patient is seen one week after surgery, and then at 6 weeks, 3 months, 4-6 months. X-rays or CT-scans are performed along the way to assess progression of fusion.

What are the benefits of a TLIF?

The main purpose of a TLIF is to improve back and/or leg pain. Patients who are good candidates for a TLIF often experience dramatic improvement in back and leg pain after recovering from surgery.

Caption:

Left: Traditional technique with extensive muscle dissection and longer incisions.

Right: New minimally invasive technique with cortical screws with a single very small incision and minimal muscle dissection still allowing for thorough decompression of the spinal nerves.

Caption:

C, D: Placement of cortical screws via a small midline incision with the screws coming in from the center of the incision allowing for minimal disruption of tissues

A, B: Traditional technique with more muscle dissection and longer recovery times.

  • American Association of Neurological Surgeons
  • American Board of Neurological Surgery
  • American Medical Association
  • The Congress of Neurological Surgeons
  • College of Physicians and Surgeons of Newfoundland & Labrador
  • North American Skull Base Society
  • North American Spine Society