TLIF ppt
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The document provides information on transforaminal lumbar interbody fusion (TLIF) surgery. TLIF aims to eliminate painful spinal motion by forming a bony bridge across the spinal segment through immobilization, a fusion bed, and bone grafting. It allows for posterior fixation and circumferential support to improve fusion rates. TLIF is indicated for degenerative disc disease, low-grade spondylolisthesis, and recurrent disc herniation with foraminal stenosis. The technique involves removing the facet joint and disc on one side, performing a discectomy, placing a bone graft in the disc space, and adding pedicle screws and rods for fixation and fusion. Complications can include blood loss, infection,
TLIF ppt
- 1. TLIF
- 2. Objective The ultimate goal of a fusion is the elimination of pathologic motion segment and its accompanying symptoms. Achieved by formation of osseous bridge across the previously mobile level. Three basic requirements for a successful fusion are Immobilization Fusion bed Bone Graft
- 4. Transforaminal lumbar interbody fusion (TLIF) reestablishes anterior column support while allowing for posterior fixation, thereby improved fusion rates because of circumferential support.
- 5. Indications Degenerative Disc disease Low Grade spondylolisthesis Multiply recurrent disc herniation and foraminal stenosis associated with deformity. TLIF is ideal for grade 1 and 2 spondylolisthesis with unilateral symptoms.
- 6. Contraindications Complete disc dessication Presence of extensive osteophytes – limits disc distraction Extensive scarring from prior posterior surgery serves as a relative contraindication.
- 9. Bone Removal Remove the entire facet joint on one side in order to allow access to the degenerated disc. Removing the facet joint and disc relieves pressure on the compressed spinal nerve, allowing it to return to the proper position.
- 11. Total discectomy and end plate preparation Total disc resection using special curettes and angled pituitary forceps under image intensifier. Marginal resection of dorsal edges of endplates.
- 12. Disc removal Damaged portion is removed.
- 13. Graft placement A single bone graft is placed in the disc space from the lateral (side) aspect through the area exposed when the facet joint was removed. The bone graft will provide stability to the spine when it fuses with the vertebrae above and below it. In variations of this procedure, spacers, cages packed with graft material, or ground bone graft material may also be packed into the disc space to aid with the fusion.
- 16. Rectangular or Bean shaped cages can be placed.
- 17. Three methods of TLIF Technique
- 18. Bone graft final positioning Central alignment of graft allows Realignment of vertebral bodies This also lifts pressure form pinched nerve roots
- 19. Preparing for fusion To prepare for additional fusion along the transverse processes, which will further stabilize the vertebrae, a motorized instrument is used to remove the top (cortical) layer of the transverse processes.
- 20. Placement of pedicle screws The construct is compressed to establish optimal bone-cage interface and reestablish lumbar lordosis.
- 21. Rod Placement Rods are placed into screws to immobilize the painful vertebral segment. The rod screw system is tightened and crosslinked.
- 22. Fusion Bone forms along the rods and bone laterally and this creates the final fusion construct.
- 23. Bone Graft Bone grafting can be done with pieces of a patient’s own bone (autograft), processed bone from a bone bank (allograft), or a bone graft substitute (demineralized bone, ceramic extender, or bone morphogenetic protein).
- 24. Closure The incisions are closed and dressed to complete the procedure. Adding the instrumentation with bone graft fusion increases the strength of the spine directly after surgery, and may decrease the need for a post-operative brace.
- 25. Final outcome
- 27. Complications Most frequent is blood loss requiring transfusion. Lumbar wound infection. Postoperative radiculitis. Cage subsidence or extrusion and pseudo arthrosis.
- 28. TLIF advantages over other fusion techniques No morbidity from retroperitoneal dissection as in ALIF. Unlike PLIF, TLIF requires minimal to no retraction on thecal sac and nerve roots while still providing 360 degrees of support. Because TLIF uses a more lateral trajectory, it can be performed in a setting of previous surgery with identifiable landmarks and cleaner plane of dissection.
- 29. Thank you.