Unilateral Transforaminal Lumbar Interbody Fusion: A Review of the Technique, Indications and Graft Materials

Transforaminal lumbar interbody fusion (TLIF) is an alternative interbody fusion procedure in which interbody space is accessed via a path that runs through the far lateral portion of the vertebral foramen. TLIF reduces the potential complications of other approaches, including the transabdominal approach or posterior lumbar interbody fusion (PLIF), but still achieves clinical outcomes and circumferential fusion results comparable with PLIF. Operative indications for TLIF are contested among many spine experts. The optimal indications for using this technique are spondylolisthesis, degenerative disc disease with a specific discogenic pain pattern, lumbar stenosis with instability and recurrent lumbar disc herniation with radiculopathy. Various instrumentation techniques and graft materials are available to use in TLIF, and each option has benefits and disadvantages. Further research is needed, however, TLIF with one cage and excised local bone and augmented with a bilateral pedicle screw seems to be an effective and affordable treatment.

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Biomechanical Comparison of Posterior and Transforaminal Interbody Fusion Constructs for the Degenerative Lumbar Spine

Advances in Bioengineering ◽

10.1115/imece2002-32633 ◽

2002 ◽

Author(s):

Stan Lee ◽

Alexander Ghanayem ◽

Scott Hodges ◽

Leonard Voronov ◽

Robert Havey ◽

...

Keyword(s):

Lumbar Spine ◽

Interbody Fusion ◽

Facet Joint ◽

Posterior Lumbar Interbody Fusion ◽

Neural Element ◽

Lumbar Interbody Fusion ◽

Disc Space ◽

Fusion Procedure ◽

Flexion Extension ◽

Circumferential Fusion

Posterior lumbar interbody fusion (PLIF) is an established technique that allows circumferential fusion of lumbar spine through a single incision. A variation of PLIF called transforaminal lumbar interbody fusion (TLIF) uses a posterior approach to the spine but accesses the disc space via a path that runs through the far lateral portion of the vertebral foramen. TLIF provides the surgeon with a fusion procedure that reduces many of the risks and limitations associated with PLIF. Like PLIF, TLIF is easily enhanced when combined with posterolateral fusion (PLF) and instrumentation. TLIF offers an advantage in that it is usually done via a unilateral approach preserving the facet joint and the interlaminar surface on the contralateral side [1]. It minimizes soft tissue stripping and neural element retraction compared to PLIF, while providing a single-stage circumferential fusion. This study compared the biomechanical performance of these two constructs in flexion, extension, and lateral bending under physiologic compressive preloads.

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A novel minimally invasive presacral approach and instrumentation technique for anterior L5–S1 intervertebral discectomy and fusion

Neurosurgical FOCUS ◽

10.3171/foc.2006.20.1.10 ◽

2006 ◽

Vol 20 (1) ◽

pp. 1-8 ◽

Cited By ~ 63

Author(s):

Nicola Marotta ◽

Murat Cosar ◽

Luiz Pimenta ◽

Larry T. Khoo

Keyword(s):

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Pedicle Screw Fixation ◽

Technical Note ◽

Minimal Risk ◽

Lumbar Interbody Fusion ◽

Disc Disease ◽

Percutaneous Pedicle Screw ◽

Lower Lumbar

Object The authors describe a new paracoccygeal approach to the L5–S1 junction for interbody fusion with transsacral instrumentation. The purpose of this technical note is to demonstrate a novel surgical approach, technique, and instrumentation system for the treatment of L5–S1 instability in degenerative disc disease and spondylolisthesis. Methods This technical note highlights the AxiaLif (TranS1) transsacral system as an alternative method to transforaminal lumbar interbody fusion or posterior lumbar interbody fusion. Via a novel presacral approach corridor, a truly percutaneous L5–S1 discectomy, interbody distraction, and fixation are achieved, and retroperitoneal viscera and dorsal neural elements are avoided. Percutaneous pedicle screw fixation is then used to provide additional stabilization at the treated level. Conclusions This novel technique of interbody distraction and fusion via a truly percutaneous approach corridor allows for circumferential treatment of the lower lumbar segments with minimal risk to the anterior organs and dorsal neural elements.

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Transforaminal Lumbar Interbody Fusion: Surgical Technique and Results in 24 Patients

Neurosurgery ◽

10.1227/01.neu.0000103493.25162.18 ◽

2004 ◽

Vol 54 (2) ◽

pp. 368-374 ◽

Cited By ~ 116

Author(s):

Sean A. Salehi ◽

Rabih Tawk ◽

Aruna Ganju ◽

Frank LaMarca ◽

John C. Liu ◽

...

Keyword(s):

Clinical Outcome ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Anterior Column ◽

Average Score ◽

Minimal Risk ◽

Lumbar Interbody Fusion ◽

Circumferential Fusion ◽

Anterior Column Support

Abstract OBJECTIVE The advantage of anterior column support and fusion in addition to pedicle fixation in patients with degenerative spinal disorders has become increasingly clear. With the increase in popularity of this treatment, a variety of techniques have been used to achieve the goal of anterior column support, fusion, and segmental instrumentation. Posterior lumbar interbody fusion has been used since the late 1940s in the treatment of degenerative lumbar spine. We evaluated a modification to posterior lumbar interbody fusion called transforaminal lumbar interbody fusion (TLIF). METHODS A retrospective analysis was performed on 24 patients (9 women, 15 men) who underwent TLIF. The approach involved a unilateral laminectomy and inferior facetectomy at the level of fusion. The interbody fusion was achieved from this unilateral approach by performing discectomy, arthrodesis, and insertion of one or two titanium cages packed with autologous bone. The average age of the patients in this study was 42.6 ± 12.5 years. Five patients were smokers. Five cases were related to workmen's compensation. Seventeen patients' original symptoms were a combination of low back pain and radiculopathy. Ten patients had had a previous spine operation. RESULTS Eleven patients had L4–S1 TLIFs. The rest of the patients had a single-level TLIF (L2–S1). Average intensive care unit and floor days were 1.1 ± 1.0 and 5.8 ± 2.2 days, respectively. The number of days to ambulation was 2.8 ± 1.6 days. There were a total of six self-limited complications in 24 patients (including one transient neurological complication). The average follow-up time was 16.9 ± 9.1 months. Twenty-two patients had solid fusions. A modified Prolo scale (4 worst, 20 best) was used to evaluate the clinical outcome. The average score was 16.1 ± 4.1. CONCLUSION TLIF is a reliable and safe technique for interbody support that can be performed with excellent clinical outcome. In the authors' experience, TLIF offers excellent exposure with minimal risk. This applies particularly in cases of repeat spine surgery, in which the presence of scar tissue makes traditional posterior lumbar interbody fusion techniques difficult or impossible. In addition, TLIF seems to be a viable alternative to anteroposterior circumferential fusion and/or anterior lumbar interbody fusion.

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Comparison of posterior lumbar interbody fusion with transforaminal lumbar interbody fusion for treatment of recurrent lumbar disc herniation: A retrospective study

Journal of International Medical Research ◽

10.1177/0300060516645419 ◽

2016 ◽

Vol 44 (6) ◽

pp. 1424-1429 ◽

Cited By ~ 3

Author(s):

Liqiang Li ◽

Yueju Liu ◽

Peng Zhang ◽

Tao Lei ◽

Jie Li ◽

...

Keyword(s):

Retrospective Study ◽

Lumbar Disc Herniation ◽

Surgical Outcome ◽

Interbody Fusion ◽

Lumbar Disc ◽

Posterior Lumbar Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Neurological Status ◽

Lumbar Interbody Fusion ◽

Recurrent Lumbar Disc Herniation

Objective To compare posterior lumbar interbody fusion (PLIF) with transforaminal lumbar interbody fusion (TLIF) for spinal fusion in patients previously treated by discectomy. Methods This retrospective study evaluated pre- and postoperative neurological status via Japan Orthopaedic Association (JOA) score. Surgical outcome was based on recovery rate percentage (RR%). Adverse event data were reviewed. Results Both PLIF ( n = 26) and TLIF ( n = 25) significantly improved neurological status. There were no significant between-group differences in postoperative JOA score, RR% or surgical outcome. Overall, 92.3% patients in the PLIF group and 84% in the TLIF group had an excellent or good outcome (RR ≥ 65%). No patient had a poor outcome (RR < 50%). There were six cases of dural tear in the PLIF group and two in the TLIF group. Conclusions PLIF and TLIF provided good outcomes for recurrent lumbar disc herniation. TLIF may be preferred because of its shorter operative time and fewer procedure-related complications than PLIF.

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Comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion in degenerative spondylosis and disc disease in a tertiary care hospital in Pimpri

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20202675 ◽

2020 ◽

Vol 6 (4) ◽

pp. 730

Author(s):

Harsh Sanjay Kumar ◽

Ajit Swamy

Keyword(s):

Blood Loss ◽

Surgical Complications ◽

Interbody Fusion ◽

Tertiary Care ◽

Posterior Lumbar Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Care Hospital ◽

Lumbar Interbody Fusion ◽

Disc Disease ◽

Significant Difference

Background: Spinal fusion in the form of transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) are the two common surgical modalities for degenerative spondylosis and disc disease. The objective of the study to compare blood loss, surgical timing, post-operative medical and surgical complications in patients treated by either modality.Methods: This was to compare prospective study of 30 patients equally divided between two modalities operated for TLIF or PLIF after conservative treatment failure.Results: There is a statistically significant difference between the blood loss, surgical time and improvement in ODI score in two groups while percentage of post-surgical complications are higher in PLIF group compared to TLIF.Conclusions: TLIF is associated with less post-operative surgical complications than TLIF which can be attributed to unilateral exposure of intervertebral disc space and requires lesser operative time and produces less blood loss.

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