A major determinant of the approach used to perform spinal fusion is the experience and confidence of the surgeon themselves. The anterior approach comes with complications surrounding major blood vessels such as the aorta and vena cava; a vascular surgeon is necessary to ensure a safe procedure in these types of operation. Surgeons often prefer, then, a posterior approach and the more recent TLIF reduces the risk of nerve trauma, muscle damage, and blood loss, in comparison to the PLIF approach. Using an approach from the side of the spine, and removing the whole facet joint on that side, the surgeon has greater access to the disc space and a greater ability to insert larger pieces of bone graft material. In PLIF surgery where smaller sections of the facet joints on either side are removed, the scope for both visual and surgical access is greatly reduced making the impact on the spinal nerves more profound and requiring more severance of muscles in order to reach the spine.
TLIF vs. PLIF
Intraoperative bleeding is also reduced using the TLIF approach as a single, smaller incision is required and less muscle is cut. The lesser degree of trauma to both spinal nerves and the back muscles means that the recovery period can be drastically reduced with no need for prolonged bed rest after surgery as with the PLIF procedure. In addition, the reduced handling of the spinal nerves means that scarring is less likely which reduces the probability of Failed Back Surgery Syndrome. Patients are usually up and walking the day after surgery, compared to a need for extended bed rest following PLIF. Whilst fusion itself can still take three to six months, the recovery from muscle damage and general surgical trauma is much reduce in TLIF surgery and patients are often able to return to work (with some restrictions) within a matter of weeks rather than months.
TLIF Outcome Data
Patients’ chronic lower back pain is improved in 60-70% of cases, with the majority of patients reporting some degree of satisfaction with the outcome of TLIF. The fusion of bone is more likely with TLIF as the grafts are placed along both lateral gutters of the spine and in the disc space increasing the stability of the spine following solid fusion. The interbody spacer also helps to restore and maintain intervertebral height, thereby reducing compression on the spinal nerves and alleviating pain from spinal stenosis. Back pain, paraesthesia, numbness, weakness, leg pain, and discomfort can all be relieved following TLIF surgery, making this a popular option for those patients who have not achieved relief with conservative or alternative treatments.
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