Transforaminal Lumbar Interbody Fusion (TLIF)

Transforaminal lumbar interbody fusion (TLIF) remains as one of the most common procedures to restore anterior column alignment and stability while allowing posterior fixation and direct neural decompression as well. TLIF also helps to restore disk and foraminal height and promotes lumbar lordosis. It is a versatile procedure with low complication rates. TLIF requires minimal retraction of the neural elements and provides excellent visualization of the critical neuroanatomical structures. The indications for TLIF are degenerative disk disease, synovial cysts that compress the dural sac or nerve roots, ipsilateral nerve root compression, recurrent disk herniation and instability owing to spondylolisthesis grade I-II. Contraindications for the procedure include complete collapsed disk space, extensive osteophytes, lytic and high-grade spondylolisthesis, multilevel (>3 levels) degenerative disk disease, and previous surgery with excessive scarring. In this chapter we describe the origins of the technique, its advantages and limitations as well as a description of the procedure in a step-by-step fashion, including a comprehensive supplementary video. The primary goal of the chapter is to provide the audience with a comprehensive guide on how to perform a TLIF avoiding complications and achieving successful decompression and fusion.