There are numerous options for spinal surgery to relieve symptoms such as back pain, difficulty in walking, leg pain, tingling, numbness, sciatica and weakness. The availability of different surgical procedures will depend on the patient’s specific condition, their general health, obesity, smoking (and willingness to quit smoking), previous surgery on the back, and other factors.
Candidates for TLIF
Patients suffering from spondylolisthesis, degenerative disc disease, disc herniation, and spinal stenosis are often candidates for the TLIF procedure in order to reduce nerve compression, restore disc height, and stabilize the spine. Conservative treatments will usually be tried for six months prior to any surgery being scheduled, unless there are signs of immediate danger of paralysis through spinal cord compression or acute trauma to the spinal nerves.
Back pain that lasts longer than six months and does not respond to conservative treatments such as medication, rest, or physical therapy usually qualifies a patient for back surgery. Fusion of the lower back may be offered where there is mechanical back pain, spinal stenosis, fracture, scoliosis, spinal instability (spondylolisthesis), recurrent disc herniation, or tumors requiring removal and fusion. Various diagnostic techniques will be used prior to back surgery such as X-Rays, MRI and CT scans, and possible myelogram, along with a thorough patient history and physical exam.
Medical Clearance for Spine Surgery
Patients should ensure that their physician is aware of all of the medications they are currently taking (and have taken recently), including both prescribed and non-prescribed pills and supplements. Some alternative remedies, such as fish oil and ginkgo biloba, can have an anticoagulant effect and may cause greater blood loss during any surgery. There may also be restrictions on medications prior to, and after, surgery that should be discussed carefully with the physician. NSAIDs are usually to be avoided as they can affect the rate of successful fusion, with patients often using narcotic medication immediately after TLIF surgery to control the pain.
Fasting prior to Back Surgery
As the procedure is performed under general anaesthetic, the patients should not eat or drink anything from midnight before the day of their surgery. If pills need to be taken then a small sip of water is allowed. No alcohol should be drunk in the few days prior to surgery and patients should have ceased smoking several weeks earlier. Smokers may not be considered as candidates for spinal fusion surgery in some cases as the chances of a poor outcome increase dramatically compared to those who have never smoked. Fusion rates for smokers have been documented at around 50-60% in contrast to 80-92% in non-smokers (Brown, 1986).
Patients may have bone harvested from their iliac crest during the procedure to provide them with an autograft for spinal fusion. In some patients this may not be desirable due to the added degree of discomfort associated with a second surgical procedure. Donor bone from a bone bank may be used instead. A third option comes courtesy of the FDA’s approval in 2003 of a process whereby stem cells can be cultured into bone forming cells and inserted into the fusion site to stimulate bone growth and union. The use of this technique can eliminate the need for the a patient’s own bone to be harvested and shortens the length of the operation.
Next Read About What Happens During: TLIF Procedure