Lumbar Fusion can also be done through an incision on the back. Space between the two vertebrae is cleared through a channel created to remove the disc material. Bone graft and cage are inserted to achieve solid fusion. This is supported by Pedicle screw instrumentation. In this procedure surgeon chooses the access to lumber spine from the back (TLIF).
Though TLIF is a good technique for lumbar fusion, it involves more muscle dissection as compared to the ALIF and OLIF technique and it is difficult to restore the normal lumbar lordosis and spine alignment through this approach.
In order to prevent nerve damage, electromyography or EMG is used for nerve monitoring, which provides surgeons the information about the the postion of nervs and surgical instruments durign the surgery.
The procedure is performed under general anasthesia. Using X-ray surgeon locates the disc and marks on the skin. An incision is made and instrument is passed to the spine and second incision is made for removing the herniated disc. On the side of vertebrae, tubular dialtors instruments are inserted through the muscles on the side of vertrae. Above them the tissue retractors are placed which has an opeing for light and instruments for accessing the disc space. The spinal disc is viewed and the disc is removed. An implant filled with bone graft for fusion is inserted into the hollow space of removed disc. Using X-ray the correctness of the postion of implant is ensured, retractors are removed and incisions are stitched and closed with dressing.