What you need to know about:

Percutaneous Transforaminal Lumbar Interbody Fusion

Fast Fact

85%

Worth It Rating

Average Cost:

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Recovery Period:

4 to 6 weeks

Permanence:

Usually permanent

177

Doctors

Time it takes:

1-3 hours

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Anesthetize:

General Anesthesia

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Overview of

Percutaneous Transforaminal Lumbar Interbody Fusion

in Thailand

Transforaminal lumbar interbody fusion (TLIF) is a procedure that involves removing an intervertebral disc from between two vertebrae and fusing them together through key-hole incision in the back. Traditionally, TLIF has been performed as an "open" technique with a larger midline incision at the back. Through this incision, the surgeon cut or strip muscle and tissue to access the vertebrae and disc space which is part of the reason that after the surgery, patients are faced with a long recovery period. Unlike the traditional TLIF procedure, our surgeons perform the TLIF by percutaneous technique with small keyhole incisions in the back. Without needs to strip muscle out of the bone, patients will have much less pain after surgery, loss less blood during surgery and get back to normal life much faster. Moreover, surgeons at Bumrungrad Spine Institute also combine the advantages of percutaneous TLIF with use of the advanced surgical navigation system called ‘O-arm’. The O-arm acts like GPS device in a car. Surgeons will see real-time high quality 3D images during surgery which resulted in more than 99% precision. These benefits lead to a shorter hospital stay and more rapid patient recovery time.

Goals of

Percutaneous Transforaminal Lumbar Interbody Fusion

TLIF can be performed for numerous spinal conditions, especially degenerative disc disease, herniated discs, or spondylolisthesis. These conditions may cause spinal cord or nerve root compression, spinal instability, and weakness. The TLIF procedure is performed to decompress (remove the pressure from) the spinal cord and/or nerves, re-stabilize the spine, and prevent further movement and degeneration at the joints in question.

Price of

Percutaneous Transforaminal Lumbar Interbody Fusion

Average Cost

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Price Range

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Pros and cons of

Percutaneous Transforaminal Lumbar Interbody Fusion

Pros

Much shorter hospital stay compared to the traditional technique. Much less postoperative pain No blood transfusion needed More than 99% precision. Walk within 24 hours after surgery.

Cons

As with any spine surgery, there are risks associated.

How it works:

Percutaneous Transforaminal Lumbar Interbody Fusion

The percutaneous TLIF is performed under general anesthesia. After the patient is positioned, the O-arm will be used to create 3D images prior to the surgery. Screws will be placed through keyhole skin incisions. Then the degenerative structures that cause nerve compression will be removed through a small tunnel with help of microscope. A bone graft is then inserted into the disc space and will act as a bridge until the bone is formed.

Preparation before

Percutaneous Transforaminal Lumbar Interbody Fusion

Pre - treatment

Since smoking affects how the bones will fuse after the procedure, it is recommended that patients stop smoking prior to a TLIF. If you currently smoke, speak to your neurosurgeon about quitting. Make sure to tell your doctor about any medications or supplements that you’re taking, especially medications that can thin your blood such as aspirin. Your doctor may recommend you stop taking these medications before your procedure. To make it easier, write all of your medications down before the day of surgery. Be sure to tell your doctor if you have an allergy to any medications, food, or latex (some surgical gloves are made of latex). On the day of surgery, remove any nail polish or acrylic nails, do not wear makeup and remove all jewelry. If staying overnight, bring items that may be needed, such as a toothbrush, toothpaste, and dentures. You will be given an ID bracelet. It will include your name, birthdate, and surgeon’s name.

Recovery after

Percutaneous Transforaminal Lumbar Interbody Fusion

Post - treatment

It is usual to feel some pain after surgery, especially at the incision site. Pain medications are usually given to help control the pain. While tingling sensations or numbness is common, and should lessen over time, they should be reported to your neurosurgeon. Most patients are up and moving around within several hours of surgery. This is encouraged in order to keep circulation normal and avoid blood clot formation in the legs. You will be able to drink after 4 hours, and should be able to eat a small amount later in the day. A CT scan will be performed the next day to check the position of the screws and cage. You will be discharged home when you are comfortable, usually after a short period of inpatient rehabilitation.

Risks & side effects

As with any spine surgery, there are risks, including the possibility of: General complications of any surgery including bleeding, infection, blood clots and reaction to anesthesia Adjacent segments degeneration syndrome You are advised to discuss the potential risks and complications with your surgeon prior to having TLIF surgery. However, risks from any surgery can be reduced by following the surgeon's instructions before and after the back surgery.

FAQs:

Percutaneous Transforaminal Lumbar Interbody Fusion

How is a percutaneous TLIF different to an open TLIF?

Percutaneous TLIF is a new minimally-invasive approach that uses smaller keyhole incisions of around 1cm to access the spine. Without the need to strip muscle out of the bone, patients benefit from less pain, less blood loss and can return to normal life in less time. Patients are often up walking within 24 hours. Traditional Open TLIF surgery is performed through an open incision in a patients back, where a larger midline incision is made. Through this opening, the surgeons cut or strip muscle and tissue to access the vertebrae and disc space. This larger entry point causes more trauma and contributes to a longer recovery period.

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Will I have any long-term limitations due to a TLIF?

The fusion portion of the TLIF is intended to prevent movement at a joint in the spine. Therefore, you will probably feel stiffness at the level of the TLIF. A fusion of two vertebrae will produce a smaller amount of stiffness; a longer fusion will produce a correspondingly longer section of stiffness.

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What is the process like after I am discharged?

You will need to wear a special brace for 3 months after surgery whilst you are sitting, standing or walking. You will need to take it easy for 8 weeks, but should walk for at least an hour every day. You should avoid sitting for more than 15-20 minutes continuously during this time. At 6-8 weeks it is likely that you will be able to return to work on “light duties” and to drive a motor vehicle on short trips. This, and the step-wise progression in your physical activities, will be determined on an individual basis. Bear in mind that the amount of time it takes to return to normal activities is different for every patient. Discomfort should decrease a little each day. Increases in energy and activity are signs that your post-operative recovery is progressing well. Maintaining a positive attitude, a healthy and well-balanced diet, and ensuring plenty of rest are excellent ways to speed up your recovery. Signs of infection such as swelling, redness or discharge from the incision, and fever should be brought to the surgeon’s attention immediately. You will be reviewed after 6-8 weeks by your neurosurgeon. Until then, you should not lift objects weighing more than 2kg, and should not engage in bending or twisting movements. The results of fusion surgery are not as good in patients who smoke or are very overweight. It is therefore important that you give up smoking permanently before your surgery and try to lose as much weight as possible. It is highly recommended that you should continue wearing your TED stockings for a couple of weeks after surgery.

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