Transforaminal Lumbar Interbody Fusion (TLIF)


A transforaminal lumbar interbody fusion (TLIF) is conducted to resect a part of an injured disc that is the source of back or leg pain. A cage and bone graft are used to fuse the spinal vertebrae after the disc is removed. Lumbar fusion surgery is performed to create solid bone between the connecting vertebra, preventing movement between the bones. The surgery aims to reduce pain and nerve irritation. A transforaminal lumbar interbody fusion (TLIF) may be recommended for conditions such as spondylolisthesis, degenerative disc disease or recurrent disc herniations and is usually combined with pedicle screw fixation.

The patient may require TLIF for the following reasons:

  • Disc prolapse leads to increased pressure on the spinal nerve roots. A herniated/prolapsed disc occurs when the outer fibres are damaged, and the soft nucleus pushes out of its protected space.
  • Lumbar canal or lateral recess/Lee’s entrance stenosis is a spinal canal narrowing that occurs more toward the sides. Stenosis of this kind affects the nerves near the spinal nerve roots.
  • Facet joint pain occurs due to facet joint syndrome, a condition similar to arthritis that causes back and neck pain. As a result, joints between the spinal bones begin to degenerate. Therefore, the facet joint can deteriorate even further, causing pain.

Of course, Dr Szabo only performs an interbody fusion when conservative methods such as pain medication, physical therapy, bracing, and nerve sheath injections have failed to provide relief.

Transforaminal Lumbar Interbody Fusion TLIF Surgery

Transforaminal lumbar interbody fusion is performed on the patient’s lower back. The process involves the surgical removal of an intervertebral disc and fusion of the vertebrae using instrumentation (screws and a cage).

TLIF consists of decompression of the nerves found in the lower back and the surgical dissection of the facet joint and intervertebral disc. Dr Szabo then inserts screws into the bones and screws above and below the bone (pedicle screws). Then, interbody fusion occurs whereby Dr Szabo places a cage into the intervertebral space to fuse the spine.


1Can you make a diagnosis before considering surgery?
A neurological exam is conducted beforehand before surgery is decided upon. Dr Szabo may consider the following tests:
  • CT scan (an early, preoperative test
  • MRI scan provides detailed information on the spinal discs and nerves
  • CT Myelogram
  • Flexion extension X-rays
  • Nerve conduction studies
  • Bone density scan (DEXA scan)
2What are the advantages of having a Transforaminal lumbar interbody fusion?
Potential benefits of TLIF include the following:
  • Minimises leg or back pain
  • Reduces tingling, muscle weakness and numbness
  • Corrects spinal instability
  • Improves back and leg function
  • TLIF guarantees a better quality of life
3What happens when I do not follow through with surgery?
Risks include:
  • Persistent pain
  • Paralysis and muscle weakness
  • Incontinence
  • Walking and balance problems