Transforaminal lumber interbody fusion(TLIF)-

Spinal fusion (such as a TLIF) is a surgical technique to stabilize the spinal vertebra and the disc or shock absorber between the vertebra.Lumber fusion surgery is designed to create solid bone between the adjoining vertebra, eliminating any movement between the bones. The goal of the surgery is to reduce pain and nerve irritation.

Indication of spinal fusion:-

• Spondylolisthesis (isthmus, degenerative, or postlaminectomy spondylolisthesis)
• Degenerative disc disease, Slip Disc , Herniated Disc , Prolapse Intervertebral Disc (PID) Complex Spinal Stenosis
• Mechanical instability due to Spinal Trauma/ Spinal Tumor / Spinal Metastasis
• Unstable spine due to spinal infection eg Tuberculosis
• Unstable spine due to Spinal Deformity- Degenrative Scoliosis

Ideal Indication

• TLIF well indicated in unilateral / far lateral discs with instability
• Root anomaly / double root
• Previous intra canal surgery
• High Lumbar PID

Advantage- TLIF verses PLIF:-

• Extra canal Technique
  • Lesser epidural fibrosis
  • Arachnoiditis
• Better Fusion Rates
• No root battering ,no post op leg pain
• Preserves Post Tension Band

Complication:-

• Dural leak
• Nerve root injury
• Wound hematoma
• Wound infection

Procedure for Spine Fusion Using TLIF Technique open :-

Steps

• Exposure
• Pedicle Screw Insertion
• Facet Resection
• Diskectomy
• End Plate preparation
• Preparation of fusion bed
• CAGE /Autograft Strut
• Graft innterbody + Intertransverse + Facet

Exposure

• TP to TP:-
  • superior – inferior
  • Left – Right
• Preserve - Upper facet capsule and intertransverse Fascia

Instrumentation Facet Resection Decompression – Indirect Diskectomy Graft bed preparation – Interbody

• Disc shavers
• Distractors and angled curettes
• Curette and rasp the end plates off cartilage
• Raw end plates – bleeding surface
  • Avoid breach of end plate
• Anterior Bone graft
  • Bone chips of the resected facet

Cage Insertion – confirm cage position

Final Screw Insertion Lower Vertebrae – ipsilateral side