Transforaminal Lumbar Intersomatic Fusion – TLIF
The goals of spinal surgery in the lumbar spine typically involve decompression of the neural elements. However, in many cases these techniques are associated with iatrogenic instability, worsening of pre-existing deformity, instability or potential development of further neurological compromise in the future.
Unilateral Technique
TLIF is a unilateral technique that allows the surgeon to access the intervertebral disc space to augment a posterior intertransverse fusion. The TLIF technique is superior to the posterior spinal fusion technique alone because the surgeon is not only able to re-establish the height of the intervertebral space, reduce spondylolisthesis and degenerative instability, and increase lordosis while maintaining spinal height through posterior fixation. This technique also allows the surgeon to increase fusion potential by obtaining a circumferential fusion surface and to treat anterior spine pathology directly, which cannot be repaired via an isolated intertransverse fusion technique. Comparing the TLIF technique with the ALIF (Anterior Lumbar Intervertebral Intervertebral Fusion) technique, it can be seen that a posterior decompression allows direct neural decompression in addition to the intervertebral technique. Exposure of the posterior fusion also allows the advantages relative to pedicle fixation to maximize and enhance stability, contribute to deformity correction, and facilitate fixation stiffness.
Risks
There are certainly risks associated with the posterior technique, which is originally neural. They are certainly easier to manage and more routine in nature than the potentially catastrophic vascular risks that are inherent to the ALIF technique. Although these aforementioned advantages are considerable, there are limitations to the posterior intersomatic technique. This is especially evident in cases with significant kyphosis, where TLIF is less capable of achieving maximum lordosis than an anterior exposure and fusion.
In summary, the rationale for TLIF is to obtain spinal support through a single posterior approach, while performing decompressive surgery and posterior fusion with instrumentation. There is also the added biological advantage of intersomatic fusion by compression through a structural fusion box that will enhance the success of the arthrodesis. There are different advantages of the TLIF approach.
Advantages of TLIF
The first and most obvious is the unilateral nature. This results in less destruction of the posterior elements and less destabilization of the spine, which will improve the stability of the fusion. Although the PLIF technique in the past offered the possibility of performing an isolated anterior and posterior procedure, the unilateral technique allows much less perineural retraction, scarring and preserves the bony surfaces for posterior fusion. This can be assured by the fact that the contralateral joint remains intact with respect to its bony anatomy. TLIF allows, as part of the dissection, much more lateral access to the neuroforamina to decompress the exiting and descending nerve without neural manipulation. This avoids nerve root retraction injuries often seen with the PLIF technique and bilateral fusions. Much more lateral access to the disc space can be made through the safety zone.
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After months of intense pain in my back and leg due to a hernia, and after being full of medications and rehabilitation sessions, finally a friend recommended this clinic and I was absolutely right. They visited me very quickly and Dr Ruiz performed a radiofrequency intervention that has solved the problem, it no longer hurts and I have regained my quality of life, which I had lost. I only have words of gratitude
I had a rhizolysis two years ago and it is the best decision I ever made. I was advised to go to this clinic. Excellent staff and treatment. I would come back without hesitation. I am a different person since I don’t feel any pain.
In a frankly desperate situation with my mother suffering from trigeminal neuralgia and with continuous and terrible pain during confinement and no public health doctor able to relieve her pain in any way, it was miraculous to find this center by surfing the internet. In just a couple of weeks after the initial visit, Dr. Ruiz operated on my mother in an outpatient and non-aggressive surgery and in just a few days she regained speech, mobility and finally began to sleep as she no longer suffered the tremendous pain. And if the treatment has been effective thanks to the hands of a great doctor, this does not mean that the whole team at the center is not deserving of credit. From the reception to the nurses, they are all exemplary professionals who make you feel safe and in good hands at all times. My mother is already another and just 4 months later we are aware that there is no better investment than health and Clínica Vértebra is a success. Totally recommendable. THANKS A MILLION.
It has been a long time since I felt what it was like to live without pain. I only have words of gratitude for the whole team, from the reception staff to the operating room team. Thank you Dr. Squarcia for such a detailed explanation of my problem and for the accuracy of the treatment. I pray to God that this wellness lasts for a long time.
I had a lumbar facet denervation (Rhizolysis) this morning and I have to say that «O» pain. It has been 10 hours since the intervention and I am still without any pain and without medication. Congratulations to the whole team. Viggo Adeler (Physician)
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It is a place that has improved my quality of life.
I only have words of thanks to Doctors Ricardo Ruiz and Dr. Matias, I have gone to them twice, and I only have words of thanks, they have solved my problem, first of Lumbar vertebrae and the second of a shoulder, and in both cases total success, I have not returned to have any kind of discomfort, I am totally grateful to them, they have changed my life. THANK YOU DOCTORS, you are fantastic.
First visit with Dr. Mattia Squarcia, finally a doctor who listens to me and looks at all my medical tests. I have already had a bad experience with another pain clinic where the doctor did not listen to me and did not even look at a single medical test.
I have only words of thanks, thank you Doctor Ricardo Ruiz.