The goals of minimally invasive transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) are to address the cause of your back pain and to keep your spine stable by fusing 2 or more of your vertebrae together.
Minimally invasive TLIF and PLIF are fusion surgeries, and although they have many similarities, the major difference between these 2 procedures is how your surgeon accesses your spine.
Posterior Lumbar Interbody Fusion (PLIF)
A PLIF may be performed to treat degenerative lumbar problems such as scoliosis or spondylolisthesis. PLIF can be performed as an open or minimally invasive procedure.
The procedure involves a laminectomy (removal of the laminae) and trimming or removal of the involved facet joints to access the nerve roots, disc, and spinal canal. The extent of the removal of facet joints may depend on the implant size and/or spinal level treated. A discectomy is performed. The spinal canal and/or nerve roots are decompressed and the implant (interbody device) is fixed in place and bone graft is added.
PLIF Potential Advantages and Disadvantages
Doing a pure PLIF surgery has the advantage that it can provide anterior fusion of the disc space without having a second incision as would be necessary with an anterior/posterior spine fusion surgery
However, it has some disadvantages:
- Not as much of the disc space can be removed with a posterior approach (from the back).
- An anterior approach provides for a much more comprehensive evacuation of the disc space and this leads to increase surface area available for a fusion.
- A larger spinal implant can be inserted from an anterior approach, which provides for superior stabilization.
- There is a small but finite risk that inserting a cage posteriorly will allow it to retro pulse back into the canal and create neural compression.
- In cases of spinal deformity (e.g. isthmic spondylolisthesis) a posterior approach alone is more difficult to reduce the deformity.
Transforaminal Lumbar Interbody Fusion (TLIF)
A TLIF is similar to a PLIF except it fuses the front and back of the spine. For example, the anterior (front) may be stabilized using an interbody device and bone graft. The posterior (rear) is fixed using, rods, pedicle screws, and bone graft.
What Are The Potential Benefits Of A TLIF?
- Reduction of leg pain, numbness, tingling and weakness
- Reduction of back pain
- Stabilisation of an unstable spine
- Medication reduction
- Prevention of deterioration
- Improved lower back and leg function
What Are The Specific Risks Of A TLIF?
Generally, surgery is fairly safe and major complications are uncommon. The chance of a minor complication is around 4 or 5%, and the risk of a major complication is 2 or 3%. Over 90% of patients should come through their surgery without complications.
The specific risks of a TLIF include (but are not limited to):
- Fail to benefit symptoms or to prevent deterioration
- Worsening of pain/weakness/numbness
- Blood clot in wound requiring urgent surgery to relieve pressure
- Injury to bowel or abdominal blood vessels when the disc is being removed
- Adjacent segment disease (deterioration of the disc above or below)