TLIF (Transforaminal Lumbar Interbody Fusion)

Overview

TLIF — Transforaminal Lumbar Interbody Fusion — is one of the most commonly performed lumbar fusion procedures worldwide, with decades of proven outcomes. It accesses the disc space through a posterior approach by removing one facet joint and entering through the foramen (the natural opening where the nerve root exits). This approach allows Dr. Basques to decompress the nerve roots, remove the damaged disc, place an interbody cage for anterior column support, and stabilize the spine with pedicle screws and rods — all through a single midline incision. The transforaminal route is advantageous because it requires retraction of only one nerve root (versus both in a PLIF), reducing the risk of nerve injury. TLIF can be performed at one or multiple levels. Dr. Basques performs both traditional open TLIF and MIS TLIF depending on each patient's specific anatomy and needs.

How It Works

Under general anesthesia, the patient is positioned face-down. A midline incision is made in the lower back. The paraspinal muscles are elevated to expose the laminae, facet joints, and transverse processes at the affected level. Dr. Basques removes one entire facet joint on the more symptomatic side to access the foramen and disc space. A laminectomy or hemilaminectomy is performed as needed for nerve decompression. The traversing and exiting nerve roots are identified and protected. The damaged disc is removed, and the disc space is prepared. A cage packed with bone graft is inserted into the anterior disc space. Pedicle screws are placed at the levels above and below, connected by contoured titanium rods. Bone graft is placed along the decorticated transverse processes and facet joints (posterolateral fusion). The incision is closed in layers. The procedure typically takes 2–3 hours per level.

Benefits

Who Is a Candidate?

Ideal candidates have lumbar spondylolisthesis (grades I–II), degenerative disc disease with mechanical low back pain, recurrent disc herniation, foraminal stenosis requiring fusion, or post-laminectomy instability. TLIF can be used at all lumbar levels and is versatile for a wide range of pathology. Dr. Basques determines whether open TLIF or MIS TLIF is the best approach based on each patient's anatomy, body habitus, and specific pathology.

Recovery & Aftercare

Hospital stay is typically 2–3 days. Walking begins on post-operative day 1. Light activities resume after 2–3 weeks. Return to desk work is typically 4–6 weeks. Heavy labor requires 3–6 months. No heavy lifting or bending for the first 6–8 weeks. A back brace may be used for comfort. Fusion solidifies over 6–12 months. Dr. Basques provides a phased return-to-activity plan with physical therapy.

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