Transforaminal lumbar interbody fusion tlif is a wellaccepted fusion technique that uses unilateral facet removal as an oblique corridor for inserting an interbody spacer. Request pdf minimally invasive transforaminal lumbar interbody fusion during the past 75 years, surgical technique, spinal instruments and instrumentation, and molecular biology have advanced. This chapter will discuss the indications for plif, including deciding between the plif and other interbody fusion techniques, the surgical technique, and complications of the procedure and their management. Your enhanced ebook allows you to access all of the text, figures, and references from the book on a variety of devices. Clinical and radiological outcomes of transforaminal lumbar interbody fusion in low grade spondylolisthesis background. Oblique lumbar interbody fusion during the last 20 years several lessinvasive anterior approaches to the lumbar spine have become standard, including the extreme lateral lumbar interbody fusion. Conditions such as spondylolisthesis, degenerative disc disease or recurrent disc herniations are known to produce mechanical pain and may be indications for a spinal fusion. Transforaminal lumbar interbody fusion tlif is a minimally invasive surgical technique used to stabilize the vertebrae. However, even though the minimally invasive surgical transforaminal lumbar interbody fusion mistlif bypasses the abdominal structures at risk with an anterior approach alif and the neural stress seen in a posterior approach plif, it still requires an open muscular dissection, and thus faces the complications of any open procedure.
Theoretical advantages of tlif include increased fusion success, more complete foraminal decompression, better correction of deformity, and more effective treatment of discogenic pain. Lumbar interbody fusion surgery austin, tx disc herniated. The transpsoas lateral lumbar interbody fusion llif technique was first introduced by pimenta and taylor in 2006 as an alternative to traditional anterior lumbar interbody fusion. Transforaminal lumbar interbody fusion tlif a transforaminal lumbar interbody fusion tlif is an effective procedure for replacing a damaged disc.
Open transforaminal lumbar interbody fusion, midlif operative technique, l5s1 olif, aspen surgical technique, and many more. Endoscopic foraminotomy for recurrent lumbar radiculopathy. Lumbar transforaminal lumbar interbody fusion tlif. Transforaminal lumbar interbody fusion tlif technique. As with any surgical procedure, interbody fusions are associated with unique. Lumbar interbody fusions 9780323476638 us elsevier health. Minimally invasive versus open transforaminal lumbar. Jun 27, 2017 theoretical advantages of tlif include increased fusion success, more complete foraminal decompression, better correction of deformity, and more effective treatment of discogenic pain. Request pdf transforaminal lumbar interbody fusion the transforaminal lumbar interbody fusion tlif is a safe, effective, and versatile technique for. Transforaminal lumbar interbody fusion tlif is a procedure used to insert a bone graft into the spinal disc space from the side position. This avoids nerve retraction injuries that are seen often with the plif and bilateral posterior interbody fusion techniques. Transforaminal lumbar interbody fusion tlif precision. Minimally invasive transforaminal lumbar interbody fusion.
We used nonpenetrating titanium clips that were originally designed for the. Spinal fusion procedures, such as a tlif, are a surgical technique that stabilizes the spine in a minimally invasive way. Although a first detailed description of the tlif technique was given by harms and jeszenszky 14 as early as 1998 the number of published papers concerning. Utilization of the transforaminal lumbar interbody fusion tlif approach for scoliosis offers the patients deformity correction and interbody fusion without the additional morbidity associated with more invasive reconstructive techniques. Transforaminal lumbar interbody fusion tlif is a procedure that fuses the anterior and posterior columns of the spine through a posterior approach. The goal of the surgery is to reduce pain and nerve. The implant must be seated firmly with a tight fit between the endplates when the segment is fully distracted. This technique involves a faster recovery time, less blood loss, and a shorter hospital stay. Tlif is designed to eliminate the disc as the source of mechanical back pain. Today, technologies such as image guidance, surgical robotics, expandable interbody spacers, and advanced spacer materials have only increased the ease and effectiveness of minimally invasive transforaminal lumbar interbody fusion mistlif for the treatment of low back pain. Pain from pinched nerves or arthritis to the disc can be severe and disabling. Lumbar interbody fusions 9780323476638 us elsevier.
The current main techniques of posterior lumbar interbody fusion plif surgery all incorporate a supplementary intervertebral implant. Threaded cylindrical cages made of titanium, cortical allograft donor bone or synthetic bone. Tlif procedure is performed through a posterior incision. Transforaminal lumbar interbody fusion tlif the spine. Transforaminal lumbar interbody fusion tlif spine surgery. Transforaminal lumbar interbody fusion mis tlif a tlif is a type of surgery involving the vertebrae and discs in the lower back, or lumbar spine.
Isass12 full abstract book the international society for the. Although it is associated with a lower risk of vascular injury compared with anterior midline approaches, neuromonitoring is considered mandatory to avoid. Transforaminal lumbar interbody fusion is a surgical technique to stabilize the spinal bones and the disc. Transforaminal lumbar interbody fusion tlif altair health. Transforaminal lumbar interbody fusion tlif is a surgical technique to stabilize the spinal vertebra and the disc or shock absorber between the vertebrae. This approach uses a much less significant incision than traditional open spinal surgeries and helps avoids damage to the low back muscles. Lumbar fusion surgery is designed to create solid bone between the adjoining vertebra, eliminating any movement between the bones. Various lumbar interbody fusion approaches are utilized to treat degenerative disc disease and spinal instability. Transforaminal lumbar interbody fusion tlif youtube. Like the plif posterior lumbar interbody fusion procedure, bone graft is used to fuse the spinal vertebrae after the disc is removed. A transforaminal lumbar interbody fusion tlif is performed to remove a portion of a disc that is the source of back or leg pain. Request pdf transforaminal lumbar interbody fusion the transforaminal lumbar interbody fusion tlif is a safe, effective, and versatile technique for treating many degenerative conditions in. Posterior lumbar interbody fusion plif is a common surgical technique used to treat the conditions mentioned above. In this technique, the spine is approached from the front by making an incision over the abdomen.
It involves placing an interbody cage in an oblique direction and a strong pedicle screw posterior construct that temporarily stabilizes the spine until bony fusion takes place via. Although the plif technique from a bilateral approach is wellknown in the clinical and academic literature, the development of the unilateral transforaminal lumbar interbody fusion tlif technique has allowed the surgeon to approach the interbody disc space posteriorly in a more efficient and isolated fashion, thereby diminishing the overall. Unlike percutaneous tlif ptlif, 29 there is no need for placement of kwires, cannulated pedicle. Modified miniopen transforaminal lumbar interbody fusion. Transforaminal lumbar interbody fusion tlif allows, as part of the dissection, a far lateral access to the neural foramina to decompress both the traversing and exiting upper nerve root without neural manipulation. A comparison of the tlif procedure to an anterior lumbar interbody fusion alif technique reveals that a posterior spinal decompression allows the surgeon to directly decompress nerves and reconstruct the spine. Transforaminal lumbar interbody fusion, mis tlif surgery. Request pdf minimally invasive transforaminal lumbar interbody fusion during the past 75 years, surgical technique, spinal instruments and instrumentation, and.
The goal of the surgery is to reduce pain and nerve irritation. The goal of fusion is to achieve stable fusion of spinal segments with good vertebral height and alignment 1. Although it is associated with a lower risk of vascular injury compared with anterior midline approaches, neuromonitoring is considered mandatory to avoid neurologic complications. Most commonly it is performed on the l4l5 or l5s1 segment at the bottom of the lumbar spine. Spine surgeons use this procedure to restore structural integrity to the vertebrae of the lumbar spine.
Another posterior surgical approach for fusion is tlif, used for. The transforaminal lumbar interbody fusion tlif technique is a modification of posterior lumbar interbody fusion plif that allows a more lateralized, onesided, and direct access to the intervertebral foraminal area without violation of the anatomical integrity of the spinal. Today, technologies such as image guidance, surgical robotics, expandable interbody spacers, and advanced spacer materials have only increased the ease and effectiveness of minimally invasive transforaminal lumbar interbody fusion mistlif for the. 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. In this study we aimed to evaluate surgical outcome of instrumented transforaminal lumbar interbody fusion tlif in the patients suffering from recurrent ldh.
Jan 26, 2019 oblique lumbar interbody fusion during the last 20 years several lessinvasive anterior approaches to the lumbar spine have become standard, including the extreme lateral lumbar interbody fusion. Miniopen transforaminal lumbar interbody fusion otlif, as described by mummanemi, 1 is a minimally invasive fusion technique that utilizes expandable tubular retractors to permit insertion of pedicle screws and tlif implants under direct vision. Open and minimally invasive transforaminal lumbar interbody. Published reports on complications associated with these surgical procedures are limited. In this procedure, bone graft, or a bone graft substitute, is placed between vertebrae in order to fuse them and create a stronger and more stable spine. Covering both minimally invasive and open procedures, this comprehensive reference provides stepbystep details for proven techniques, including. Spinal fusion such as a tlif is a surgical technique to stabilize the spinal vertebra and the disc or shock absorber between the vertebra.
Lumbar interbody fusion is a recognized surgical technique in treatment of. Instrumented transforaminal lumbar interbody fusion in. The incidence of recurrence in patients undergoing primary discectomy due to lumbar disc herniation ldh, is regularly reported as 515%. This surgery is used to treat serious spinal diseases that cause chronic low back pain and radiculopathy. Surgical technique transforaminal lumbar interbody fusion tlif page 2 of 5 preoperative planning preoperative planning is necessary for the correct selection of lumbar interbody fusion devices. Transforaminal lumbar interbody fusion tlif duration. Mis minimally invasive surgery tlifs transforaminal. Tlif transforaminal lumbar interbody fusion when the spines discs wear our there is often associated pain and collapse of that disc causing nerves to become pinched. The surgical technique of minimally invasive transforaminal lumbar. Transforaminal through the opening below the nerve lumbar low back, involving one or more of the last 5 intervertebral discs. It involves placing an interbody cage in an oblique direction and a strong pedicle screw posterior construct that temporarily stabilizes the spine until bony fusion takes place.
During the procedure, the surgeon enters the impacted area through a small incision on the patients back, directly above the affected vertebrae. Surgical approaches for fusion include posterior lumbar interbody fusion plif 2. In a recent clinical study of 50 minimally invasive keyhole transforaminal lumbar interbody fusion procedures, all patients reported immediate improvement with symptoms. During tlif, a board certified spine surgeon essentially welds two painful vertebrae together so they heal. Durotomy repair in minimally invasive transforaminal lumbar. Transforaminal lumbar interbody fusion tlif, ozgur. Durotomy repair in minimally invasive transforaminal. Medical text books minimally invasive spine surgery in chicago. Closure of the dura defect may be easy to perform in open lumbar surgery but could be difficult in minimally invasive transforaminal lumbar interbody fusions mistlif since mistlif was done through a small tube, which limited the use of standard dural repair instruments.
A posterior lumbar interbody fusion, called a plif, is a surgery designed to stop the motion at the targeted segment of the spine. The surgical technique of minimally invasive transforaminal lumbar interbody fusion. We retrospectively studied 51 patients 30 female, 21 male from august 2007 to october 2011. The advantage of this approach is that it requires less movement of the nerve roots. Apr 15, 2015 transforaminal lumbar interbody fusion tlif is performed for conditions, including spinal stenosis, degenerative scoliosis, and spondylolisthesis of the lumbar spine. In transforaminal lumbar interbody fusion tlif, your surgeon approaches the disk space slightly more from the side. Transforaminal lumbar interbody fusion tlif is performed for conditions, including spinal stenosis, degenerative scoliosis, and spondylolisthesis of the lumbar spine. Tlif back surgery indications and technique spinehealth. Royal oak ibfd system surgical technique transforaminal.
The surgical technique of minimally invasive transforaminal. A transforaminal interbody lumbar fusion is a particular type of fusion, or surgical procedure that permanently fuses, or unites, bones of the spine. This manuscript focused on five cases of endoscopic foraminotomy for patients presenting with recurrent radiculopathy after tlif procedures. The spine is composed of 33 vertebrae that create the spinal column, which provides the main support for the body. Jan 26, 2005 the unilateral transforaminal lumbar interbody fusion tlif represents an alternative surgical technique avoiding both the anterior approach and the approach through the spinal canal. Posterior lumbar interbody fusion techniques have been popular since the 1950. Sep 15, 2016 miniopen transforaminal lumbar interbody fusion otlif, as described by mummanemi, 1 is a minimally invasive fusion technique that utilizes expandable tubular retractors to permit insertion of pedicle screws and tlif implants under direct vision. The transforaminal lumbar interbody fusion tlif technique is a modification of posterior lumbar interbody fusion plif that allows a more lateralized, onesided, and direct access to the intervertebral foraminal area without violation of the anatomical integrity of the. Posterior lumbar interbody fusion and transforaminal.
Transforaminal lumbar interbody fusion in nyc hudson medical. This textbook covers all the modern technical aspects of lif to keep it relevant. Transforaminal lumbar interbody fusion tlif back surgery. Minimally invasive tlif transforaminal lumbar interbody fusion. The unilateral transforaminal lumbar interbody fusion tlif represents an alternative surgical technique avoiding both the anterior approach and the approach through the spinal canal. Transforaminal lumbar interbody fusion tlif facet joint removed to gain access to the disc for removal nerve root facet joint left intact cage inserted into disc space front front transverse process posterior lumbar interbody fusion plif front front disc removed and space for cage created surgical instrument holding the nerve out of the way.
Minimally invasive transforaminal lumbar interbody fusion tlif. However, the tlif procedure places a single bone graft between. Lumbar fusion is an effective treatment for low back pain secondary to degenerative lumbar pathology. Ab the posterior lumbar interbody fusion plif was first described by cloward in 1953.
A bone graft and interbody spacer stabilize the anterior portion while the posterior is locked in place with pedicle screws, rods and bone graft. What outcome can i expect after a transforaminal lumbar interbody fusion. This surgery may be done to treat lumbar degenerative disc disease, in. This is a problem that can be fixed with a new approach. Transforaminal lumbar interbody fusion burak ozgur, md. The surgical options for interbody fusion of the lumbar spine include. Open transforaminal lumbar interbody fusion tlif has been performed for many years with the aim of improving fusion rates and disc height restoration as compared with the traditional interbody fusion technique. Indications when used as an intervertebral body fusion device, the royal oak ibfd system is indicated for intervertebral body fusion of the lumbar spine, from l2 to s1, in skeletally mature patients who have had six months of nonoperative treatment. Transforaminal lumbar interbody fusion request pdf. The technique of posterior lumbar interbody fusion plif is an important skill in. Further, posterior decompression exposure allows for the advantages of pedicle fixation to maximize and enhance spinal stability. Transforaminal lumbar interbody fusion advanced relief. Authored by experienced surgeons and key innovators in the fastmoving field of lif surgery, lumbar interbody fusions provides an indepth, focused approach to recent advances in surgical techniques and technology.
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