TLIF, PLIF, and Spinal Fusion for Spinal Stenosis
Where spinal fusion does occur, a patient may have a small portion of bone taken from their iliac crest (pelvic bone) to provide graft material, or donor bone can be used. Synthetic bone protein is also used on occasion along with the usual metal instrumentation to attach the graft and support the spine as the new bone fuses. If spinal fusion is conducted at the back of the spine without fusion at the anterior spine then this may, over time, lead to stress and strain due to poor anterior support.
The Difference Between PLIF and TLIF
The TLIF (transforaminal lumbar interbody fusion) procedure can effectively remedy stenosis in the lumbar spine whilst restoring and maintaining the intervertebral height. In this operation the surgeon makes an incision in the side of the back of the spine and removes the facet joint on one side of the problem disc space. The disc is removed and an interbody spacer is inserted between the vertebrae to ensure that the spine does not begin to tilt or collapse without the cushioning of the disc. The bone graft between the vertebrae fuses over time to form a solid long bone with the vertebrae above and below. This approach avoids the added complication of a procedure performed using both an anterior and posterior incision or the posterior lumbar interbody fusion (PLIF) which requires access from both sides of the facet joints. PLIF procedures can inflict more pronounced trauma on the spinal nerves as instrumentation is squeezed through the foramina to access the disc space. The recovery time is often higher with a PLIF procedure due to the necessity of cutting muscle and ligament at both sides of the spine for access; bruising and bleeding are less extensive with TLIF leading to a reduced recovery time.