Transforaminal Lumbar Interbody Fusion: Indications and Techniques

Published on 13/03/2015 by admin

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Last modified 13/03/2015

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Chapter 170 Transforaminal Lumbar Interbody Fusion

Indications and Techniques

Lumbar fusion is an accepted treatment for spinal deformity, iatrogenic instability following decompressive procedures, and more controversially refractory axial back pain caused by degenerative disease of the spine.1 Lumbar interbody fusion yields certain advantages over posterolateral fusion alone, particularly because of higher rates of fusion.2 Segmental motion still exists with posterolateral fusion alone, but this motion is significantly reduced with fusion techniques through the intervertebral disc space.3,4 Biomechanically, the disc contributes significantly to anterior column stability, and the stabilizing influence of a posterolateral fusion depends on an intact anterior column.5 Transforaminal lumbar interbody fusion (TLIF) reestablishes anterior column support while allowing for posterior fixation, thereby imparting improved fusion rates because of circumferential support.6 Furthermore, as an interbody technique, TLIF helps restore disc and foraminal height and promotes lumbar lordosis.7 TLIF obviates the morbidity from the retroperitoneal dissection and subsequent posterior fixation required from anterior lumbar interbody fusion (ALIF). And unlike posterior lumbar interbody fusion (PLIF), TLIF requires minimal to no retraction on the thecal sac and nerve roots while still providing 360 degrees of support. In addition, because TLIF utilizes a more lateral trajectory, it can be performed in the setting of previous surgery with identifiable landmarks and a cleaner plane of dissection.

Surgical Technique

In general, TLIF utilizes an imagined quadrangular space between the transverse processes of the vertebral bodies adjacent to the affected disc space and the traversing nerve root medially (Fig. 170-1). Both open and minimally invasive techniques are utilized. The open technique is described stepwise, followed by modifications for the minimally invasive procedure.

Minimally Incisional TLIF

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