Lumbar Interbody Fusion PLIF & TLIF

Doing a pure PLIF surgery has the advantage that it can provide anterior fusion of the disc space without having a second incision as would be necessary with an anterior/posterior spine fusion surgery. However, it has some disadvantages:

• Not as much of the disc space can be removed with a posterior approach (from the back).
• An anterior approach (an ALIF, from the front) provides for a much more comprehensive evacuation of the disc space and this leads to increase surface area available for a fusion.
• A larger spinal implant can be inserted from an anterior approach, which provides for superior stabilization.
• In cases of spinal deformity (e.g. isthmic spondylolisthesis) a posterior approach alone is more difficult to reduce the deformity.
• There is a small but finite risk that inserting a cage posteriorly will allow it to retro pulse back into the canal and create neural compression.

TLIF procedure has several theoretical advantages over some other forms of lumbar fusion:

• Bone fusion is enhanced because bone graft is placed both along the gutters of the spine posteriorly but also in the disc space.
• A spacer is inserted into the disc space helping to restore normal height and opening up nerve foramina to take pressure off the nerve roots.
• A TLIF procedure allows the surgeon to insert bone graft and spacer into the disc space from a unilateral approach laterally without having to forcefully retract the nerve roots as much, which may reduce injury and scarring around the nerve roots when compared to a PLIF procedure.

As with all forms of lumbar spine fusion, prior to TLIF surgery medical clearance is obtained. Smoking should be stopped. Patients may require pre-donation of blood to be used at the time of surgery.