Denton County Living Well Magazine May/June 2017 | Page 29

Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF)
using Cortical Bone Trajectory Screw Fixation
A
By M. Viktor Silver, MD, FRCSC, FACS, FAANS
transforaminal lumbar inter-
body fusion (TLIF) is a surgical
procedure that stabilizes the
spine and reduces back and
leg pain by joining two or
more vertebral bones by fusing them with
bone forming across the disc space. This
minimally invasive technique is used to
prevent abnormal movement and allow-
ing for restoration of disc height which
then relieves the pressure on the spinal
nerves and alleviates leg and back pain
without having to open the patient from
the front or abdomen and back or a
“360” fusion as some of those surgeries
are known.
With this minimally invasive procedure,
the entire surgery is done from the back.
The final advantage is that by using this
new minimally invasive screw placement
technique, cortical screw fixation,
the surgery can be done with only one
small incision not too different in size
from a simple surgery for removal of a
herniated or degenerated disc.
Who is a candidate for a TLIF with
Cortical Screws?
Patients with back pain and leg pain,
weakness, or numbness who have failed
conservative measures (physical therapy,
medication, injections, etc.) and who
have evidence of disc degeneration or in-
stability on MRI and for a number of oth-
er reasons, including bulging, missing,
or compromised discs, narrowing of the
spinal canal or spinal stenosis, degenera-
tive disc disease, and spondylolisthesis.
What is a minimally invasive sur-
gical approach?
Minimally invasive spine surgery is per-
formed through a small incision in the
back and uses intraoperative X-ray, tu-
bular retractors, and special instruments
to avoid extensive damage to the back
muscles and sometimes computer or ro-
bot guidance.
Outer gray area: Traditional
technique with extensive muscle
dissection and longer incisions.
Center darker gray area: New
minimally invasive technique with
cortical screws with a single very
small incision and minimal muscle
dissection still allowing for thorough
decompression of the spinal nerves.
Minimally invasive surgery has many
Right, center: Placement of cortical screws
via a small midline incision with the screws
coming in from the center of the incision al-
lowing for minimal disruption of tissues and
less pain post-operatively.
advantages
over
traditional (or open)
spine surgery that
include smaller inci-
sions, less blood loss,
smaller scars, a short-
er hospital stay, less
pain during recovery,
and a faster return to
work and daily activi-
ties.
What is the recovery like?
The patients typically spend 2-3 days in
the hospital. The main restrictions are
no heavy lifting (no more than 10 lbs.
for the first 3 months) and no repetitive
bending or twisting at the waist.
Most patients return to light duty or
office-type work in 4-6 weeks. Physical
therapy is started between 6 and 12
weeks, if necessary.
What follow-up care
is necessary?
The patient is seen one week after sur-
gery, and then at 6 weeks, 3 months,
4-6 months. X-rays or CT-scans are per-
formed along the way to assess progres-
Small midline
incision similar in
size to one of a
simple removal of
a herniated disc
through which a
circumferential
or “360-degrees”
fusion can be
performed without ever needing to open the
patient from the abdomen.
sion of fusion.
What are the benefits of a TLIF?
The main purpose of a TLIF is to improve
back and/or leg pain. Patients who are
good candidates for a TLIF often experi-
ence dramatic improvement in back and
leg pain after recovering from surgery.
Dr. Silver is a double-board certified Neurosurgeon by the American Board of Neurological Surgery and by the Royal College of
Physicians and Surgeons of Canada. He graduated from one of the largest neurosurgical training centers in North America only to
further specialize in the treatment of Spine Disorders.
Learn more about Dr. Silver’s state-of-the-art office by visiting www.silverneurosurgery.com.
DENTON COUNTY Living Well Magazine | MAY/JUNE 2017
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