What Is Transforaminal Lumbar Interbody Fusion (TLIF)?

TLIF is a spinal surgery designed to stabilize the vertebrae and discs in the spine. The procedure involves removing an intervertebral disc, which serves as a shock absorber between two vertebrae. Then, the surgeon joins the vertebrae together with a cage and screws. 

TLIF stands for:

• Transforaminal, which means through the foramina, which are the openings in the spine where your nerve bundles exit into the body
• Lumbar, which is the lower spinal cord
• Interbody, meaning between the vertebral bodies
• Fusion, which is where two bones grow together into one

During TLIF surgery, your doctor will enter the posterior of the spine and:

• Apply surgical hardware to facilitate fusion of the vertebrae and discs
• Attach screws and rods to the back of the vertebra
• Insert an interbody fusion spacer between the discs
• Remove a bone graft from the pelvis (or use a bone graft substitute)
• Allow the healing bone graft to fuse to the vertebra both above and below the surgery site

The procedure decompresses the spinal cord, removing the painful nerve pinching that causes leg numbness. It also stabilizes the spine to prevent further degeneration of this important structure. 

TLIF is an effective procedure in relieving back pain and numbness. This was certainly the case for Dr. Goll’s patient, Ralph. Today, he says, “The symptoms are gone. I’m really looking forward to a brief period of rehabilitation and getting back on the golf course.” 

If you have lower back pain and leg numbness due to debilitating spinal conditions, and other non-invasive treatments no longer work, TLIF surgery may be right for you. 

TLIF is typically indicated for patients with:

• Degenerative disc disease, which is when the discs gradually deteriorate with age, injury, or excessive use
• Recurrent herniated discs, which occur when the soft interior of the spine pushes through to the outside of the disc
• Spondylolisthesis, a condition where a defect in the spine causes vertebrae to slip to one side of the body

Ralph, a patient who qualified for TLIF under these criteria, says his pain wasn’t as bad as the numbness he felt, which he describes as “limiting.” 

He describes, “I could only walk maybe if I got to a quarter-mile, then my legs would be numb.” Normal, everyday tasks such as grocery shopping were very limited because it would bring on the numbness in his legs.

Fortunately, TLIF was able to eliminate these symptoms for Ralph. There are several benefits to the TLIF procedure, particularly over other forms of lumbar fusion:

• The bone graft is strategically placed to enhance the bone fusion process
• A spacer goes between the discs to restore the spine to its normal height
• The spacer helps reduce spinal compression

If you’re experiencing leg numbness and pain, you may be wondering if spinal surgery is your only option. Are there less invasive ways to approach your spinal health?

Every person’s health journey is an individual one. Depending on the cause of your back pain, your doctor may not recommend spinal surgery at all. Your doctor may try other less invasive procedures first before considering TLIF surgery.

That’s what happened in Ralph’s case. Ralph commented that Dr. Goll, “took a very conservative approach with physical therapy and some medication, and also the spinal injections.” Dr. Goll tried these less invasive measures first before attempting surgery. Unfortunately, these treatments didn’t help.

Some of the types of non-invasive procedures your doctor may consider before surgery include:

• Acupuncture
• Anti-inflammatory diet
• CBD oil
• Better footwear
• Exercise
• Improving posture
• Over-the-counter pain relief
• Physical therapy
• Spinal manipulation, commonly known as chiropractic
• Stress management
• Transcutaneous electrical nerve stimulation (TENS)
• Weight loss

Every doctor is different, as are the situations and goals of the patients they serve. In Ralph’s case, he was very pleased with Dr. Goll’s approach. He says, “My first impression was that he was very confident and I was also very impressed with the fact that he took a conservative approach first and didn’t recommend surgery until it was the last resort. To me that was very reassuring.”

Surgery shouldn’t necessarily be the go-to for your doctor. We know that the TLIF procedure improves back pain in the vast majority of patients. 80% say they are satisfied with the surgical results. As with any surgery, there are risks associated with having the procedure done. This includes possible nerve damage or a reaction to the anesthesia. Patients considering spinal surgery should have a candidate discussion with their doctor about all of their options.

Ralph says he was very comfortable with the surgical approach. He mentioned the excellent care he received from Dr. Goll. Ralph says, “He was very direct and explained the procedure very clearly.” Today, Ralph is back to the activities he used to enjoy before back and leg pain sidelined his life. 

If you are suffering from back pain, please contact us at Orlando Orthopaedic Center to find out how we can help you regain your health.