Transforaminal Lumbar Interbody Fusion
Information about your procedure:
The intervertebral disc is the structure between the vertebrae (bones of the spine), which acts as a spacer and a shock absorber. Disc degeneration can cause inflammation in the surrounding area and can be a source of continuing back pain and pain in the thighs and buttocks, stiffness, muscle tightness and tenderness.
Following your investigations and consultation with your spinal surgeon, the possibility of you undergoing TLIF has been discussed with you. The decision to have this operation to treat lower back pain caused by degenerative disc disease is a very personal one. For the most part, degenerative disc disease is a non-progressive type of back condition and for the majority of people their symptoms will improve over time (up to ten years). Patients need to carefully consider the risks and possible complications along with the potential benefits of surgery.
Surgery for lower back pain caused by degenerative disc disease is only considered an option for patients who:
Have not had sufficient pain relief from extensive non-surgical treatment for at least a year;
Have ongoing lower back pain that limits their ability to perform everyday activities at work or at home.
About the procedure
The operation is carried out under general anaesthetic, through an incision in the back. After removal of some bone, the disc material is removed and the cage, containing bone graft, is placed in the space created. Your own bone will, over time, grow into the bone graft. The system is completed with screws (usually four, depending on the number of levels involved) and rods, in order to stabilise the spine while the fusion progresses.
Risks and complications
Risks include the following:
Damage to the nerve root and the outer lining which surrounds the nerve roots (dura). This is reported in < 5% of cases. It may occur as a result of the bone being very stuck to the lining and tearing it as the bone is lifted off. This could result in back or leg pain, weakness or numbness, leaking from the wound, headaches or, very rarely, meningitis.
Bleeding. You must inform your consultant if you are taking tablets used to thin the blood, such as warfarin, aspirin or clopidogrel.
Deep wound infections may occur in < 1% of cases. These can be more difficult to treat with antibiotics alone and sometimes patients require more surgery.
Bony non-union. This can occur in up to 5%.
Ongoing back and leg pain (sciatica)
Rarely, the surgery may make your symptoms worse than before.
Implant movement can occur in up to 2%, with 1% requiring re-operation. In extremely rare cases, cage movement can cause cauda equina syndrome (paralysis, bladder or bowel incontinence).
What to expect in hospital
Immediately after the procedure you will be taken on your bed to the recovery ward where nurses will monitor your blood pressure and pulse. Once back on the ward and when you are fully awake you will be allowed to get out of bed. You will have a plastic tube (drain) coming from the wound, that will prevent any blood collection in the wound. This will be removed on the ward the next day and removal is not painful.
You will normally be discharged home with simple analgesia 2-3 days after your operation. Please arrange for either a friend or relative to collect you from the hospital, as driving yourself or taking public transport is not advised for 48 hours after the anaesthetic. A responsible adult should remain with you overnight. You will walk as comfort allows from the day after the surgery.
In general, you may return to work in 4 weeks provided that you are comfortable. We will provide a sick note at your request on the day of the procedure, if necessary.
Follow-up in 2 weeks for wound check.