Transforaminal Lumbar Interbody Fusion: 4 Things to Know

1. TLIF is cost-effective. In addition to reporting that patients experienced less disability and improved quality of life, a study presented at the American Association of Neurological Surgeons annual meeting showed that the total cost per Quality Adjusted Life Years gained of TLIF was $42,854, which is well below the accepted $50,000 cost-effective threshold. The average two-year direct medical cost of TLIF was $25,251, with the surgical cost amounting to approximately $21,311. The average reported income prior to surgery was $50,000, and patients missed an average of 60 days of work. This represents a two-year societal cost of $11,584.

2. Performing minimally invasive TLIF. The transforaminal lumbar interbody fusion procedure is well-known among spine surgeons, and new advances in technology have made it possible to perform the TLIF on patients with chronic back pain as a minimally invasive procedure. When performing the procedure, surgeons use fluoroscopy and insert a small tube through the skin until it reaches the spine. The surgery is performed through the tube. Because the approach is less invasive, it decreases infection rates and blood loss and promotes a faster recovery.

3. Complication rates. While fusion rates for open and minimally invasive TLIF are similar and relatively high, an article published in Spine shows that minimally invasive TLIF usually has lower complication rates. Studies evaluated in the article represent data from 1,028 patients, and found that the use of recombinant bone morphogenic protein was higher among the minimally invasive group. The open group reported a 12.6 percent complication rate, compared with the minimally invasive group, which reported a complication rate of 7.5 percent.

4. Risk for postoperative osteolysis. The use of rhBMP-2 in TLIF can be associated with an increased risk of postoperative osteolysis, according to an article published in Spine. The researchers examined 58 patients who underwent TLIF, with all patients receiving 5 milligrams of rhBMP-2 per level. Osteolysis was found in 27.6 percent of the patients, but there wasn’t a significant difference between patients undergoing a single- or multi-level fusion. The average osteolysis was 12.5 millimeters.