Unilateral Transforaminal Lumbar Interbody Fusion: A Review of the Technique, Indications and Graft Materials

Abstract

Transforaminal lumbar interbody fusion (TLIF) is an alternative interbody fusion procedure in which interbody space is accessed via a path that runs through the far lateral portion of the vertebral foramen. TLIF reduces the potential complications of other approaches, including the transabdominal approach or posterior lumbar interbody fusion (PLIF), but still achieves clinical outcomes and circumferential fusion results comparable with PLIF. Operative indications for TLIF are contested among many spine experts. The optimal indications for using this technique are spondylolisthesis, degenerative disc disease with a specific discogenic pain pattern, lumbar stenosis with instability and recurrent lumbar disc herniation with radiculopathy. Various instrumentation techniques and graft materials are available to use in TLIF, and each option has benefits and disadvantages. Further research is needed, however, TLIF with one cage and excised local bone and augmented with a bilateral pedicle screw seems to be an effective and affordable treatment.