TLIF surgery at Yapita Health

What is TLIF surgery?

TLIF surgery is a good option if your back issues have not eased with the help of primary treatment options such as physical therapy or pain management. The surgery involves removing and replacing intervertebral disks in the lower back.

The bones that make up the spine have intervertebral disks that separate and cushion them. These wear out and put pressure on the spinal nerves which run through your spine. This pressure is what you feel as chronic “back pain.”

If you are wondering how painful is TLIF surgery, it is not painful as your surgeon will use anesthesia. And it is not administered randomly - your doctor and anesthesiologist (anesthesia expert) will conduct pre-anesthetic checkup.

Source of back or leg pain. The TLIF procedure places a single bone graft between vertebrae instead of two such as in case of PLIF. Now that you know what is TLIF surgery, let’s have a look at who the surgery is suitable for?

The surgery is suitable for people experiencing lower back pain and leg pain due to sciatica or other lumbar radiculopathy. You can benefit from the surgery if you have:

• Spinal stenosis

• Spondylosis

• Degenerative disc disease

• Recurrent disc herniation

• Spinal instability

• Pseudoarthrosis

TLIF Surgery Procedure

The TLIF back surgery is different from the PLIF in that the former uses a side approach through transforaminal space while the latter relies on the back of the spine. This is how the TLIF procedure goes:

Step 1: Incision - A TLIF is performed to remove a portion of the disc which is causing leg or back pain. This requires a small incision on the lower back, above the lumbar vertebrae. The incision allows the surgeon to remove the compressed disc.

This is where the bone graft will be fused. The bone graft is inserted from the side instead of the back. Additionally, the area surrounding this disc is also hollowed.

A grasping instrument helps remove the entire facet joint on one side - allowing access to degenerated disc.

Step 2: Decompression - Removing the facet joint relieves pressure on the compressed spinal nerve. This allows proper repositioning of the spinal nerve. Now the area is clear for placing the bone graft.

Step 3: Graft placement - A single bone graft is placed in the cleared disc space from the side. This bone graft provides stability to the spine as it fuses with the vertebrae around it. To aid with fusion, ground bone graft material or cages (spacer) packed with graft material are filled in the disc space.

Step 4: Fusion - The transverse processes or the costiform processes are prepared to further improve stabilization. A motorized instrument helps remove the top layer where the bone grafts are added.

A drill helps create holes in the pedicle area where the screws will go in.

Step 5: Spine stabilization - The surgeon will next put screws into the bone just above and below the affected disks and place a rod between them. The rod and screw prevent the vertebrae from moving while the bone graft fuses.

Bone grafting can be done with the patient’s bone (known as autograft) from a bone bank (allograft) or a bone graft substitute (demineralized bone, ceramic extender or bone morphogenetic protein.)

In case of autograft the bone is removed from the iliac crest and placed along the prepared site where the bone from top layer was removed.

This increases the stability of the spine after surgery.

The incisions are closed and dressed to complete the procedure.

The cost of TLIF surgery in India can be around $10,000-$15,000, while that in Western countries such as the US and Germany can be three to five times the cost - around $50,000-$80,000.

What happens before the surgery?

Just like any other invasive surgery, before this procedure, your medical team will ask questions that help determine your fitness. This is necessary to ensure you are a good candidate for the surgery. They will:

• Check your medical history.

• Check results of or conduct blood tests to check your health.

• Ask about your medications or supplements that may interfere with the procedure.

• Stop smoking or using tobacco in any form as it hinders healing.

• Discuss bone graft material that will replace your damaged disk.

• Seven days before the surgery you will be asked to limit your alcohol consumption and NSAIDs or anticoagulants that you may take.

The surgery can take around two to three hours.

Risks and benefits of the procedure

Here are the risks associated with the surgery:

• Infection (rare)

• Bleeding (< 1% cases)

• Injury to the nerves

• Need for revision surgery (in case of complications such as adjacent segment degeneration, failure of fusion.)

How do you benefit from the surgery:

• Relief from sciatica pain

• Better spine stability

• Improves quality of life

• Reduction in medication dependence

• Helps restore natural height and curvature of the spine which is lost due to degenerative conditions.

• Decompression of nerves which restores sensation in the feet and legs.

Is minimally invasive TLIF surgery worth the hype? 

It is said that people can get the best benefits with the help of the minimally invasive procedure. This procedure involves creating smaller incisions and less muscle dissection that promotes faster recovery.

In comparison to traditional open surgeries, this type uses a tubular dilator that creates the working space for the surgeon. This dilator helps the surgeon access the spinal area without significant muscle damage.

Minimally invasive TLIF can cost around $8,000-$12,000 in India while that in the US and other Western countries can be $50,000-$1,10,000.

The cost of either of the surgery types can depend on the surgeon’s fee, hospital stay, number of discs that have to be replaced and the cost of anesthesia, post-op PT and medications.

For example, if person X requires two-level TLIF, you can expect the cost to go up to $25,000 in India, while it can go up to $300,000 in the US.