Transforaminal Lumbar Interbody Fusion Surgery (TLIF)
Transforaminal Lumbar Interbody Fusion (TLIF) is a minimally invasive posterior lumbar fusion procedure — performed through the back — that fuses one or more levels of the lumbar spine to treat instability, spondylolisthesis, recurrent disc herniation, and degenerative disc disease causing persistent back and leg pain.
Overview
What is TLIF Surgery?
Transforaminal Lumbar Interbody Fusion (TLIF) is a minimally invasive posterior lumbar fusion procedure — performed through the back — that fuses one or more levels of the lumbar spine to treat instability, spondylolisthesis, recurrent disc herniation, and degenerative disc disease causing persistent back and leg pain.
The acronym describes the technique: Transforaminal — the disc is accessed through the foramen (the opening where the nerve exits the spine) on one side, by removing the facet joint; Lumbar — the lumbar spine or back is treated; Interbody — fusion occurs across the disc space between two vertebral bodies; Fusion — a permanent bony bridge is created between the vertebrae, stabilising the segment.
One Brain and Spine's neurosurgeons perform TLIF using minimally invasive techniques with advanced spinal navigation whilst utilising the most up-todate intra-operative equipment to maximise safety and while minimising muscle disruption and recovery time.
When is TLIF Recommended?
TLIF is recommended when spinal stabilisation is required in addition to nerve decompression. Common indications include:
- Spondylolisthesis — slippage of one vertebra on another, requiring stabilisation
- Spinal instability — abnormal motion between vertebral segments
- Recurrent disc herniation — particularly after previous surgery at the same level
- Degenerative disc disease with significant back pain and disc collapse
- Severe foraminal stenosis requiring facet joint removal
- Failed previous decompression surgery
Procedure
Preoperative Preparation
MRI and standing X-rays (including flexion-extension views to assess instability) may be obtained to confirm the surgical plan. A CT scan and DEXA bone density scan may also be obtained. Blood thinners are ceased before surgery.
What Happens During TLIF?
The procedure is performed usually under general anaesthesia with the patient prone (lying on their stomach). Occasionally a TLIF under spinal block may be offered, particularly if the risks of proceeding with a general anaesthetic is high. Two small incisions in the lower back just off the midline during this procedure. Specialised retractors are then placed with minimal muscle disruption to allow the surgeon to gain access to the relevant spinal level. On the symptomatic side, the facet joint is removed (facetectomy), and the nerve root is decompressed. The intervertebral disc is removed through the transforaminal corridor, and an interbody cage packed with bone graft is inserted into the disc space to promote fusion and restore spinal height and alignment.
Pedicle screws are then placed bilaterally at the affected level — guided by intraoperative navigation or robotic assistance — and connected with titanium rods to rigidly stabilise the spinal segment. Specialised nerve monitoring (SSEP and MEP) may be used throughout to protect nerve function.
The procedure typically takes 2 to 4 hours for a single level. Hospital stay is around 2 to 4 days.
MIS TLIF Advantages Over Open Surgery
- Smaller incisions — typically two 3–4cm incisions versus a single 10–15cm open incision
- Reduced muscle disruption — specialised retractors dilate rather than cut paraspinal muscles
- Less blood loss — lower transfusion rates
- Reduced postoperative back pain
- Shorter hospital stay
- Faster return to normal activities
Outcomes & risks
Outcomes of TLIF Surgery
TLIF is highly effective for spondylolisthesis and spinal instability — greater than 80–90% of appropriately selected patients achieve significant improvement in leg pain and walking tolerance. Back pain improvement is less predictable but occurs in the majority. Fusion rates with modern techniques and bone graft substitutes exceed 90% at 12 months.
Risks and Complications
General Surgical Risks
- Wound infection — approximately 1–2%; higher for multilevel procedures
- Bleeding — intraoperatively or postoperatively; rarely requires return to theatre
- CSF leak — approximately 1–2%
Fusion-Specific Risks
- Non-union (pseudarthrosis) — occurs in 5%, this denotes the failure of the bones to fuse and is more common in smokers, multi-level surgery, and patients with poor bone quality. Pseudoarthrosis may require revision surgery
- Adjacent segment disease — accelerated degeneration at levels above or below the fusion
- Nerve injury (1%) — persistent or worsening leg pain, numbness, or weakness
- Implant malposition or failure (1%) — minimised by intraoperative navigation
- Persistent back pain — fusion does not guarantee resolution of back pain
- Bowel or bladder dysfunction — rare
Frequently Asked Questions — TLIF Melbourne
What is the difference between TLIF and PLIF?
Both are posterior interbody fusion techniques, but differ in approach. TLIF accesses the disc from one side through the foramen (transforaminal), removing one facet joint and placing a single cage. PLIF approaches the disc centrally from the back, requiring bilateral retraction of the nerve roots to place two cages. TLIF is generally preferred as it requires less nerve root retraction, reducing the risk of nerve injury.
How long until I know if the fusion has worked?
Initial stability is provided immediately by the pedicle screw and rod construct. Bony fusion develops over 6 to 12 months. A CT scan at 12 months confirms solid fusion. Most patients experience progressive improvement in symptoms over this period.
Will I lose back flexibility after TLIF?
Fusion at the treated level permanently eliminates motion at that segment. For single-level fusion, most patients notice little functional difference in daily activities. Multi-level fusion causes more restriction. Adjacent levels compensate over time and most patients return to all daily activities.
Do I need rehabilitation after TLIF?
Inpatient rehabilitation is recommended for elderly patients, those living alone, or those with multiple levels treated. Formal physiotherapy commences at the 4-week review and continues for several months. A structured progressive walking programme from day one is the most important recovery activity.
Why Choose One Brain and Spine?
One Brain and Spine is a specialist neurosurgical group practice in Melbourne, led by three experienced, fellowship-trained neurosurgeons. We provide expert care across the full spectrum of spine surgery using minimally invasive techniques, advanced navigation, and intraoperative neuromonitoring.
The Neurosurgeons are One Brain and Spine are recognised as experts in TLIF fusion surgery. They are educators and trainers for less experienced surgeons embarking on TLIF surgery and regularly host visiting surgeons during the teaching process. The collective experience at One Brain and Spine in TLIF fusions is in excess of 700 cases.
- Specialist neurosurgeons — fellowship-trained with subspecialty spine expertise. Proctors for spine fusion teaching. Invited speakers and faculty for international spine conferences in Spine Fusion Surgery.
- Full range of spine surgery techniques — minimally invasive, endoscopic, and open
- Intraoperative navigation, robotics and neuromonitoring — accuracy, safety and efficiency optimised for you
- Patient-centred, personalised care
- All major health funds accepted