Pain After Transforaminal Lumbar Interbody Fusion Surgery
Transforaminal Lumbar Interbody Fusion, more commonly referred to as TLIF, is a popular type of posterior spinal fusion surgery. It is performed on patients with several types of back and leg pain, including:
- Degenerative Disc Disease
- Recurrent Disc Herniation, and More
TLIF is a type of posterior approach to spinal fusion, which means that the patient’s spine is accessed through the back, but it differs from a similar procedure, known as PLIF (for posterior lumbar interbody fusion), because the spine is accessed through one side rather than straight through the back.
Many surgeons prefer TLIF to PLIF because it is associated with few complications. There is less risk of dural tera, inflammation, blood loss, and other issues that could result in the recurrence of pain. But while TLIF tends to be more successful than PLIF, between 5% and 10% of patients that undergo the procedure will have new, recurring, or worsening pain. If this occurs, it means the TLIF has failed.
What Does it Mean to Have “Failed TLIF?”
Spine surgery is designed to reduce or eliminate chronic pain. If you have any type of chronic pain after surgery that is not associated with recovery, spine surgeons refer to this as a “failed” surgery. If the patient underwent the transforaminal lumbar interbody fusion procedure, then the patient is said to have “failed TLIF.”
There is no single reason for failed TLIF. Possible causes include:
- Poor Candidate Selection
- Surgical Error
- Bone Graft Failure
- Nerve Compression
- Excessive Scar Tissue
- Adjacent Segment Disease/Pain
The type of pain may differ greatly depending on the location, the cause, and the extent of the damage or issue. There may also be tangentially related symptoms, such as incontinence or leg weakness, if the cause is related to nerve damage, although these symptoms are rarer. In general, most patients that have failed TLIF have severe pain in some form despite undergoing surgery to cure chronic pain.
Is TLIF Failure Common?
TLIF tends to be a more successful surgery than PLIF, but all posterior spinal fusion surgeries carry a greater risk of failure than anterior (frontal) fusion surgeries, simply due to the way that weight is placed on the spine, how the surgery is performed, and other factors.
Although 80% of spine surgeons use some form of posterior spinal fusion, including TLIF, it does carry a higher risk for failure than anterior fusions, and all spine surgery has a chance for failure.
What is the Treatment for Failed TLIF?
It’s important to emphasize that the term “failed” encompasses all potential causes of pain after TLIF surgery, which means that treatment for failed TLIF requires an extensive diagnosis.
One of the goals we have here at Spine Center Atlanta is to perform as many tests as required to fully diagnose what may be causing your pain to occur, because only with that type of in-depth diagnosis from those that have specific expertise in failed spine surgeries (like Dr. Chappuis, Petilon and his team here at Spine Center Atlanta) can we truly recommend a treatment that will reduce or eliminate the pain.
Nevertheless, our first goal is to see if the pain can be managed or eliminate using non-surgical means. If there is a structural issue, however, revision spine surgery may be necessary. In some cases, it may be prudent to consider a revision lumbar fusion of some kind, perhaps using the more successful anterior approach. At other times, a different surgical approach may be required.
It’s difficult to recommend any treatment without a complete and thorough examination. But failed TLIF can be treated. Here at Spine Center Atlanta, we see patients from across the United States that are struggling with pain after back surgery, and we’ll do whatever we can to treat it effectively. For more information, or to schedule an appointment, please call us today at 404-351-5812.