Transforaminal Lumbar Interbody Fusion

Interbody fusion performed by placing spacers or graft materials via a transfacetar route is named transarticular lumbar interbody fusion (TLIF). TLIF is typically performed via a unilateral approach and can be performed via a standard open approach with a midline lumbar incision or in a less-invasive mini-open fashion (see Chap. 49). Because the TLIF approach uses a unilateral facetectomy, it is typically combined with screw fixation (see Fig. 52.1). Advantages compared to bilateral PLIF are contralateral facet joint and posterior laminar arch are preserved and iatrogenic contralateral scar formation is eliminated. Further, exposure of the disc space requires less or no medial dural retraction. This can be particularly advantageous in the face of scarring after prior surgery and in the thoracolumbar area, where the myelon restricts the retraction of the thecal sac.