Patient Education

Transforaminal Lumbar Interbody Fusion

Q: How long does a TLIF procedure take?

Approximately 2–3 hours, although duration depends on the number of levels treated, anatomy, degree of stenosis, and whether more extensive decompression is required.

Q: How many days will I stay in the hospital?

Typically 2–4 days. Discharge depends on pain control, mobility, overall condition, and safety at home.

Q: When is fusion considered “complete”?

Fusion is gradual and may continue for up to approximately 12 months. You will receive a follow-up plan and activity guidance to properly support the healing process.

Q: When can I drive or return to work?

Driving is typically allowed once you can move comfortably and are not taking strong pain medication, and only after medical clearance. Return-to-work timing varies: desk work may resume in weeks, while physically demanding work usually requires longer recovery—plans are individualized.

Q: Why is quitting smoking or nicotine so important before and after fusion?

Nicotine impairs healing and can significantly compromise fusion, increasing the risk of non-union and infection. Quitting meaningfully improves the chance of a successful outcome.

Q: Will I need physical therapy?

Often yes—at the appropriate time. We typically begin with safe mobilization and walking, then progress to core strengthening and postural training when medically appropriate, to improve function and reduce recurrence of pain.

Transforaminal lumbar interbody fusion (TLIF) is a form of lumbar spinal fusion designed to stabilize a painful or unstable spinal segment while decompressing the affected nerves. During the procedure, the damaged intervertebral disc is removed and replaced with bone graft inside a specialized cage, while screws and rods provide stability until solid fusion occurs.

Appointment / Case Evaluation The Neuroknife Team

GOAL

Stabilization + relief of nerve compression

WHY IT IS DONE

Disc disease/instability/stenosis causing pain or neurologic symptoms

DURATION

Typically ~2–3 hours (depends on levels & anatomy)

HOSPITAL STAY

Often 2–4 days (individualized)

What is TLIF?

Transforaminal lumbar interbody fusion (TLIF) is a procedure used to treat chronic low back pain and/or symptoms caused by nerve compression due to disc damage, degeneration, instability, or spinal stenosis. In simple terms: we remove the source of instability and compression at a specific spinal level and create the conditions for the vertebrae to fuse together in a stable alignment.

The intervertebral disc acts as a “cushion” between the vertebrae. When it degenerates or is injured, it may cause pain due to mechanical instability or compress nearby nerves, leading to leg pain, numbness, or weakness. TLIF allows access through the transforaminal corridor, enabling the surgeon to decompress the nerves and place a cage with bone graft into the disc space.

Important: spinal fusion is not a one-size-fits-all solution. It is considered when a specific spinal level is clearly responsible for symptoms and when conservative treatments (physical therapy, medications, injections, etc.) have failed to provide meaningful improvement.

Why is lumbar interbody fusion performed?

TLIF is recommended when one or more lumbar levels require a combination of stabilization and neural decompression. The goal is to reduce pain, restore function, and protect the spinal nerves.

Common indications

Degenerative disc disease with persistent pain despite treatment
Spondylolisthesis (vertebral slippage) with instability or nerve compression
Spinal canal or foraminal stenosis with symptoms (leg pain, numbness)
Recurrent disc herniation in selected cases
Certain forms of scoliosis or degenerative deformity, when indicated

How we determine if it is appropriate

Clinical findings: back pain, leg pain, neurologic deficits
Imaging: MRI/CT, flexion–extension X-rays to assess instability
Correlation: imaging findings must match the patient’s symptoms
Failure of adequate conservative management over a reasonable period

Before surgery

Preparation aims to maximize safety and optimize healing and fusion quality. In spinal fusion procedures, adherence to instructions (especially smoking/nicotine cessation) is critical.

Confirming the indication

Discussion of goals, alternatives, realistic expectations, and the specific levels to be treated.

Medical evaluation & medications

Blood tests, cardiac/anesthesia assessment, and instructions regarding anticoagulants or anti-inflammatory medications.

Nicotine/smoking cessation

Nicotine impairs bone healing and fusion. Complete cessation is strongly recommended according to medical guidance.

Recovery planning

Arranging hospitalization, home support, and clear instructions regarding walking and activity restrictions in the first weeks.

How is transforaminal lumbar interbody fusion performed?

TLIF may be performed as an open or minimally invasive procedure, depending on anatomy, number of levels, and surgical strategy. Below is an overview of the key surgical steps.

Incision & access to the level

A posterior incision is made in the lumbar region. With careful tissue handling and fluoroscopic guidance, the surgeon accesses the selected level while minimizing tissue trauma.

Neural decompression

Structures that narrow the spinal canal or foramen (e.g., bone spurs, hypertrophic joints) are removed to relieve nerve compression.

Disc removal & cage placement

The diseased disc is removed and the intervertebral space is prepared. A cage filled with bone graft is placed to facilitate fusion.

Screws and rods for stabilization

Pedicle screws and rods are inserted to stabilize the segment until solid fusion is achieved.

What “fusion” means

The goal is the formation of new bone connecting the vertebrae.
This is a gradual biological process that may continue for months.
Instrumentation maintains alignment and stability while fusion matures.

After surgery: recovery & return to activity

Recovery after TLIF is multiphase: early mobilization (days–weeks), functional recovery (weeks–months), and maturation of fusion (months up to ~1 year).

What to expect in the hospital

Monitoring of vital signs and pain control
Early mobilization with guidance (walking, safe movements)
Instructions on posture, sleep, and wound care
Discharge when walking, nutrition, and pain are safely controlled

At home (practical guidance)

Daily short walks with gradual activity progression
Avoid heavy bending, twisting, or lifting
Driving: only when cleared by your surgeon and not using strong analgesics
Physical therapy/core exercises when indicated and at the appropriate time

Full recovery is individualized. In fusion surgery, stabilization is achieved gradually, and bone healing may continue for up to 12 months after surgery.

Risks & potential complications

Every surgical procedure carries potential risks. Our goal is transparency without exaggeration: what may occur, how we reduce risk, and when you should contact your care team promptly.

Examples may include

Infection
Bleeding / hematoma
Deep vein thrombosis / pulmonary embolism (prevented with mobilization and protocols)
Anesthesia-related complications
Nerve irritation or injury (rare) with pain, numbness, or weakness
Cerebrospinal fluid leak
Incomplete or delayed fusion (pseudoarthrosis)
Hardware-related pain or need for revision in selected cases

Note: Risk varies based on diagnosis, anatomy, and overall health and is discussed in detail on an individual basis.

When to contact us immediately

After discharge, contact our team if any symptom is new, worsening, or concerning.

Contact us promptly if you experience

Fever, chills, or signs of wound infection (redness, discharge, increasing pain)
Sudden or significant worsening of pain not controlled with medication
New or worsening weakness or numbness in the legs
Difficulty with urination or bowel function, or incontinence
Shortness of breath, chest pain, or calf swelling/pain

Frequently asked questions (FAQ)

Answers to common questions we hear from patients before and after transforaminal lumbar interbody fusion (TLIF). All guidance is individualized by our team.

How long does a TLIF procedure take?

Approximately 2–3 hours, although the duration depends on the number of levels, anatomy, degree of stenosis, and whether more extensive decompression is required.

How many days will I stay in the hospital?

Typically 2–4 days. Discharge depends on pain control, mobility, overall condition, and safety at home.

When is fusion considered “complete”?

Bone fusion is gradual and may continue for up to approximately 12 months. You will receive a follow-up plan and activity guidance to properly support this process.

When can I drive or return to work?

Driving is permitted once you can move comfortably and are not taking strong pain medication, and always with medical clearance. Return-to-work timing varies: desk work may resume in weeks, while physically demanding work typically requires a longer recovery—plans are individualized.

Why is quitting smoking/nicotine so important?

Nicotine impairs healing and significantly compromises fusion, increasing the risk of non-union and infection. Cessation meaningfully improves outcomes.

Will I need physical therapy?

Often yes—at the appropriate time. We begin with safe mobilization and walking, then progress to core strengthening and postural training when medically appropriate, to improve function and reduce recurrence of pain.

Consult with a specialized spine team

If you have been advised to undergo lumbar fusion or are considering fusion for pain, instability, or stenosis, we can review your imaging (MRI/CT/X-rays) and discuss a safe, individualized plan — surgical or non-surgical — tailored to your anatomy and goals.

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