These two acronyms stand for:
1) TLIF - Transforaminal Lumbar Interbody Fusion
2) PLIF - Posterior Lumbar Interbody Fusion
As the name suggests both these procedures resault in the permanent fusion of two or more spinal vertebra together to elliminate the instability that has been causing your symptoms. They are generally the last resort in the long term magament of back pain when either more conservative treatment is not appropriate (immediate danger to the nervous system) or conservative treatment has failed.
We have an operative booklet that all our clienjts recive prior to their surgery to inform them about the procedure itself, immediate post op rehabilitation and the ‘do’s and don’ts’. This is availbel to download in the pdf booklet section of this site. It is free to all however should you be undergoing surgery by another team you should follow their own guidelines implicitly and we cannot be responsible for any procedural variations.
The two operations have three important stages:
1) The intial boney removal to allow entry
2) The cage insertion
3) The fixation at the back.
Stage three is common to both so this will be discussed at the end but stages one and two will be discussed individually below.
PLIF
The anatomy of the spine provides great protection to its vital compenents however this means it is inherently diificult to access the large front body where the disc sits. To allow sufficient ‘room to work’ we remove a central area of the bony complex and thick ligaments at the rear of the spine.
The following diagram demonstrates th insertion of the two separate cages in betqween the large verterbral bodies and where they sit, one to the left and one to the right. To help with orientation, the diagram is taken from above with the front of the spine at the bottom and rear at the top. The purple tubular structure is the spinal card and the nerve roots as they exit the cord.
At this point the fiaxtion at the rear of the spine in then performed. Please see below.
TLIF
This procedure uses only one cage and so we only need one access point.
For orientation purposes again, these following diagrams are looking from above with the font of the vertebra at the bottom and the rear at the top.
The rear fixation is now undertaken, please see below.
Cages
As you you now know each of the procedures has a diffrent type of cage and just for reference purposes they are clearly shown on the diagream below.
Final Fixation
It is common practive to secure the fusion with a second fixation to the back portion of the spine. There are some types of cages that are ’stand alone’ that don’t need these however they are normally inserted through a surgical incision in your tummy and not your back (ALIF/STALIF - see own dedicated page).
After the screws and rods are firmly placed and the overall positioning of botht he fusiona and spine is satisfactory futher bone graft material is place around the metal word. This will encourage a boney ridge to form over time further securing the fusion for good longevity.
If you would like to learn more about these individual techniques then the links below contain excleent descruiptions and animations. Please note that there are some minor procedural differences due to them being American sites and different suregeons. For learning and reference purposes howeve they are all well worth a read!
Spine Universe PLIF Spine Health PLIF
Spine Health PLIF Spine Health TLIF
Understand Spinal Surgery TLIF
Surgery
Prior to any surgical intervention we always get our clients to fill in a questionnaire that consists of the Oswestry Disability Index (ODI) and a Visual Analogue Score (VAS). These are both very short and simple but enable us to obtain a base line for your symptoms. In the case of the PLIF and TLIF surgery this questionnaire is then completed at 3,6 and 12 months at your folow up visits and then allows us a validated compariosn. This simply enables us to monitor your progress.
The ODI consists of 10 questions which when all completed are scored and a percentage applied. There are five catagories that this allows us to place you within from minimal to bedbound. The two graphs below represent the average change during the first year follow up post surgery. The baseline scores are an average of those clients that fall into this range for example the ‘minimal group’ percentage range is 0-20 (has progressive 20 % ranges) however for the TLIF patients the average of this group was 14%. This system then follows through at 3,6 and 12 months to give the average score of the group at that point. It gives you an idea of the improveents ad times lines involved. We update this every 6-12months to keep it as current as possible. The figures represnt those undergoing surgery from May 07-08. Although this appears a ong time ago you must allow for the one year follow up period to conclude.
Click here to see the pre op booklet in the pdf section.
