Transforaminal Lumbar Interbody Fusion

WHAT YOU SHOULD KNOW:

• Transforaminal lumbar interbody fusion, also called TLIF, is surgery to correct problems with your spine (backbone). The spine is made up of bones called vertebrae that are like blocks placed on top of each other. Usually, the spine is straight when seen from the back and like a letter 'S' from the side. The spine protects the spinal cord, and nerves coming to and from the spinal cord. In between the vertebrae are discs, which are soft cushions. These help your vertebrae move softly over each other when you twist or bend your body. TLIF may be done when you have crooked, loose, or broken vertebrae in the lumbar spine (lower back). It may also be done when the discs rupture (burst), causing vertebrae to grind into each other. You may have leg and low back pains, or numbness and weakness in your legs.
  
  
• During surgery, your caregiver will make an incision (cut) on your back over the affected area. A special device is used to cut bone around the foramen (opening where the nerve passes) of the vertebrae. Enlarging the foramen takes pressure off the nerve root and gives your caregiver more room to do the TLIF. Two or more vertebrae are joined together using bone grafts or implants, and special tools such as screws and rods. Grafts are bones taken from another part of your body. The special tools are used to hold the repaired bone in place and to stop the affected vertebrae from slipping further. With surgery, pain in your back may be treated, and you may resume your usual activities.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

There are always risks with surgery, such as infection or bleeding too much. You could have trouble breathing or get blood clots. Other parts near your spine, such as nerves, blood vessels, ligaments, muscles, and bones may be damaged. You may develop weakness of your foot or lose feeling in your legs afterwards. Even after the surgery, you may still have back pain, or have problems moving your back. You may have trouble going back to your usual activities, including sports. If left untreated, the pain and problems you have with your back may get worse. You may even have problems moving your legs. Call your caregiver if you are worried or have questions about your surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• Monitoring:
  
  
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
    
    
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• Tests:
  
  
  • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
    
    
  • Computerized tomography scan: This is also called a CT or CAT scan. An x-ray machine uses a computer to take pictures of your back. It may be used to look for injury or abnormal changes in bones or muscles.
    
    
  • Magnetic resonance imaging: This is also called MRI. During the MRI, pictures of your back are taken. An MRI may be used to check the parts of your back, such as the muscles and blood vessels. It may also be used to look for other problems.
    
    
  • X-rays: Before surgery, caregivers may want to have an x-ray (picture) of your back. Caregivers use it to see the injury inside your back before surgery.

During your surgery:

• You are asked to lie on your stomach on the operating table. Your back is cleaned with soap and water. This soap may make your skin yellow, but it will be cleaned off later. Sheets are put over you to keep the surgery area clean.
  
  
• An incision (cut) is made on your back to see the affected vertebrae. Muscles, ligaments, and blood vessels are carefully moved aside. Bones around the vertebral foramen are carefully chipped off to give more room for your caregiver to work in. The foramen is a small opening between vertebrae where nerves exit at both sides of the spine. Once the spine is seen, the disc and excess tissues in the affected area are removed. Bone grafts and implants are inserted between the affected vertebrae in place of the damaged disc. Screws and rods are used to hold the bone graft and implant firmly. The incisions are closed with stitches (threads) and covered with a bandage.

After your surgery:

You may be taken to a recovery room until you are fully awake. Caregivers will watch you closely for any problems. Do not get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages used to cover your stitches keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your wound.

• Activity:
  
  
  • Until you can get out of bed, start doing leg exercises. Do this by drawing circles with your toes. This will make your legs stronger and stop blood clots from forming.
    
    
  • It is important to get moving as soon as possible after surgery. Ask your caregiver when you can get up for the first time. Any time you feel weak or dizzy, lie down right away and call your caregiver.
  
  
• Food and drink after surgery: You will able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft food easily, you may slowly begin to eat solid foods.
  
  
• Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.
  
  
• Medicines: You may be given the following medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Medicines to treat pain, swelling, or fever: These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease or a history of bleeding in your stomach.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.