TLIF

Transforaminal lumbar interbody fusion (TLIF) is a surgical procedure used to achieve fusion of a lumbar spinal segment by placing an interbody graft or cage into the disc space through a transforaminal window on one side of the spine. Developed in the late 20th century as an alternative to posterior lumbar interbody fusion (PLIF), TLIF aims to allow adequate neural decompression with less bilateral disruption of posterior elements and paraspinal muscles.

Indications for TLIF include degenerative spondylolisthesis, spinal stenosis with instability, degenerative disc disease, recurrent disc herniation, and certain spinal deformities. The procedure can be performed at one or more lumbar levels and is available in open and minimally invasive (MIS) forms. TLIF is often chosen when there is a need for both neural decompression and stabilization with a solid interbody fusion.

Surgical technique typically involves a posterior approach. After exposing the affected level, a laminectomy and foraminotomy are performed to decompress neural elements. The disc space is prepared, and an interbody cage or bone graft is inserted obliquely through the foraminal window. Pedicle screws and rods are placed posteriorly to provide stabilization, and graft material is used to promote fusion. MIS TLIF uses tubular retractors and targeted discectomy to minimize muscle dissection while achieving a similar biomechanical goal.

Outcomes generally show relief of radicular symptoms and improvements in function, with fusion rates reported as high in selected patients. Potential complications include durotomy, nerve or vascular injury, infection, hematoma, and hardware failure. Long-term considerations include adjacent segment degeneration and the need for revision in a minority of cases.