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.

Getting Ready

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using any of your present medicines. These may include aspirin, ibuprofen, or blood thinners.
  
  
• Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.
  
  
• You may need a blood transfusion if you lose a large amount of blood during surgery. Some people are worried about getting AIDS, hepatitis, or the West Nile virus from a blood transfusion. The risk of this happening is very low. Blood banks test all donated blood for AIDS, hepatitis, and the West Nile virus. You may be able to donate your own blood before surgery. This is called autologous blood donation. This must be done no later than three days before surgery. You may also ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before surgery. You may need to check your blood sugar more often before and after having surgery.
  
  
• If you are a woman, tell your caregiver if you know or think you are pregnant.
  
  
• You may need to have different blood and urine tests. Imaging tests, such as x-rays, computerized tomography (CT) scan, or magnetic resonance imaging (MRI) may also be done. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

• Remove any nail polish.
  
  
• You may be given a pill to help you sleep.
  
  
• Ask caregivers about directions for eating and drinking.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

Treatment

What will happen:

• You will be asked to change into a hospital gown. You will be given medicine to help you relax or make you drowsy. You will be taken on a stretcher to the room where the surgery will be done. A medicine called general anesthesia will be given to keep you asleep and free from pain during the surgery. You will be asked to lie on your stomach on the operating table. Your back will be cleaned with soap and water. This soap may make your skin yellow, but it will be cleaned off later. Sheets will be put over you to keep the surgery area clean.
  
  
• An incision (cut) will be made on your back to see the affected vertebrae. Muscles, ligaments, and blood vessels will be carefully moved aside. Bones around the foramen will be carefully chipped off. The foramen is an 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 will be removed. Bone grafts and implants will be inserted between the affected vertebrae in place of the damaged disc. Screws and rods will be used to hold the bone graft and implant firmly. The incisions will be closed with stitches (threads) and covered with a bandage.

After surgery:

You are taken to a room where your heart and breathing will be monitored. Do not get out of bed until your caregiver says it is okay. A bandage may cover wounds to help prevent infection. You may be able to go home after some time passes. An adult will need to drive you home and should stay with you for 24 hours. If you cannot go home, you will be taken to a hospital room.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have a fever.
  
  
• You have a skin infection or an infected wound near the injured area of your spine.
  
  
• You have questions or concerns about your surgery.

Seek Care Immediately if

• The problems for which you are having the transforaminal lumbar interbody fusion get worse.
  
  
• You have a lot more pain or have trouble moving your back.

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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.