Back surgery carries all of the usual surgical risks such as superficial or deep infection, blood loss, and adverse reaction to the anaesthesia used. Thrombophlebitis, and stroke are also risks which can be mediated to some degree. The reduced surgical time of the TLIF procedure can help reduce some of these risks, as can the minimally invasive approach and complications such as these only arise in around 1-3% of cases. Blood loss is less severe in this type of back surgery in comparison to the conventional PLIF surgery where patients are often advised to pre-donate blood for transfusion due to the bleeding of the muscles cut in this procedure. Blood loss is still present to some degree and patients are given pre-surgical advice to help reduce problems with bleeding, such as ceasing any anticoagulant medications, and not drinking alcohol in the days leading up to their surgery.
TLIF Surgery Infection
Infection of the incision site, or of the bone can occur in TLIF, and some surgeons recommend the use of prophylactic antibiotics to reduce the risk of infection. Any patient who has signs of an infection prior to surgery will have their surgery delayed until no infection is present. Careful monitoring of the incision site and general well-being is important after surgery in order to catch any infection early and apply proper treatment. In rare cases the infection can necessitate additional surgery and the instrumentation may need removing along with any infected material. Autografts are rarely rejected after spinal fusion surgery, and techniques to reduce rejection by the immune system of donor bone material or other instrumentation have significantly improved the chances of a fusion occurring without complication.
Nerve injury is a specific risk of back surgery, although the TLIF procedure does have a reduced risk of nerve trauma when compared to some other spinal surgeries. Nerves may be damaged when pushed aside to give the surgeon access to the disc space. Scarring (fibrosis) can occur leading to compression of the nerves. In extreme cases the nerves may be cut by accident resulting in numbness, weakness, and paralysis. Nerve damage may be reparable, but in some cases the effect of the trauma will be permanent. Muscle damage can also occur, with scarring and resulting pathology of the back muscles. Again, this is greatly reduced using the TLIF technique.
Failed Bone Graft Union
A risk in TLIF surgery is that a solid union will not occur between the bone grafts and the vertebrae. The pain may the continue and further degeneration occur. If fusion does not occur then further surgery may be required in order to attempt to stabilize the spine to a greater degree. Not all non-union cases require further back surgery, however, as a joint may become stable even without a solid fusion occurring. If the patient’s symptoms have improved then further surgery is often unnecessary. Patients who are obese, smoke, or have had radiation therapy prior to the TLIF surgery are less likely to have a successful outcome. Those having fusion performed across multiple levels are also at an increased risk of complication and non-union.
TLIF surgery has the advantage of forming a fusion bridging the anterior and posterior segment of the spine and can, therefore, reduce the risk of compression, slippage, curvature, and fracture of the vertebrae. The fusion of one or more segments of the spine may, however, transfer some of the stresses on the spine to other vertebrae leading to problems of compression, and fracture in other regions. There is no guarantee that spinal fusion will be successful, using the TLIF technique or any other. In rare cases a solid union occurs but patients’ symptoms are not relieved. Patients should ensure that they understand the risks and possible benefits of TLIF thoroughly before scheduling surgery. In the majority of cases complications do not occur, and a good fusion is achieved, thereby relieving the symptoms of chronic low back pain.
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