Transforaminal lumbar interbody fusion (TLIF) is a common lower back surgical procedure that aims to eliminate motion in the treated spinal segment and allow the fusion of bone. The surgery is comparatively less invasive than other spine fusion surgeries and helps preserve vital ligaments and reduce the risk of neural injury. 1 Hozumi T, Orita S, Inage K, et al. Successful salvage surgery for failed transforaminal lumbosacral interbody fusion using the anterior transperitoneal approach. Clin Case Rep. 2016;4(5):477-480. Published 2016 Mar 29. doi:10.1002/ccr3.553 , 2 de Kunder SL, van Kuijk SMJ, Rijkers K, et al. Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J. 2017;17(11):1712-1721. doi:10.1016/j.spinee.2017.06.018 , 3 Fleege C, Rickert M, Rauschmann M. PLIF- und TLIF-Verfahren. Indikation, Technik, Vor- und Nachteile [The PLIF and TLIF techniques. Indication, technique, advantages, and disadvantages]. Orthopade. 2015;44(2):114-123. doi:10.1007/s00132-014-3065-9 , 4 Singhatanadgige W, Suranaowarat P, Jaruprat P, Kerr S, Tanasansomboon T, Limthongkul W. Indirect effects on adjacent segments after minimally invasive transforaminal lumbar interbody fusion [published online ahead of print, 2022 Aug 24]. World Neurosurg. 2022;S1878-8750(22)01197-4. doi:10.1016/j.wneu.2022.08.087 , 5 Teng I, Han J, Phan K, Mobbs R. A meta-analysis comparing ALIF, PLIF, TLIF and LLIF. J Clin Neurosci. 2017;44:11-17. doi:10.1016/j.jocn.2017.06.013

While TLIF is considered a safe and effective method of achieving lumbar fusion, failure of bony fusion, migration of the cage, and misplacing of screws may occur in rare cases, 6 Epstein NE. Lower complication and reoperation rates for laminectomy rather than MI TLIF/other fusions for degenerative lumbar disease/spondylolisthesis: A review. Surg Neurol Int. 2018;9:55. Published 2018 Mar 7. doi:10.4103/sni.sni_26_18 providing incomplete symptom relief.

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Success Rates of TLIF Spine Surgery

Studies indicate that most cases of TLIF show favorable results:

  • There may be a 60% to 70% improvement in pain after a TLIF spinal fusion surgery 7 de Kunder SL, van Kuijk SMJ, Rijkers K, et al. Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J. 2017;17(11):1712-1721. doi:10.1016/j.spinee.2017.06.018
  • Both open TLIF and minimally invasive TLIF have a high fusion rate of around 90% 8 Kim CH, Easley K, Lee JS, et al. Comparison of Minimally Invasive Versus Open Transforaminal Interbody Lumbar Fusion. Global Spine J. 2020;10(2 Suppl):143S-150S. doi:10.1177/2192568219882344
  • More than 80% of patients undergoing TLIF spinal fusion surgery are satisfied with the surgical result 9 Lim JBT, Yeo W, Chen JLT. Preoperative Leg Pain Score Predicts Patient Satisfaction After Transforaminal Lumbar Interbody Fusion Surgery. Global Spine J. 2018;8(4):354-358. doi:10.1177/2192568217723888

TLIF fusion rates are similar to the other approaches to spinal fusion, as seen at the 2-year mark after surgery. 10 Wasinpongwanich K, Nopsopon T, Pongpirul K. Surgical Treatments for Lumbar Spine Diseases (TLIF vs. Other Surgical Techniques): A Systematic Review and Meta-Analysis. Front Surg. 2022;9:829469. Published 2022 Mar 14. doi:10.3389/fsurg.2022.829469 Patient satisfaction is nearly 95% 2 years following a TLIF surgery. 6 Epstein NE. Lower complication and reoperation rates for laminectomy rather than MI TLIF/other fusions for degenerative lumbar disease/spondylolisthesis: A review. Surg Neurol Int. 2018;9:55. Published 2018 Mar 7. doi:10.4103/sni.sni_26_18

In This Article:

Potential Risks and Complications for TLIF Back Surgery

The benefits of TLIF spinal surgery must be weighed against potential complications from the procedure. TLIF has an overall complication rate of about 8.7%. 4 Singhatanadgige W, Suranaowarat P, Jaruprat P, Kerr S, Tanasansomboon T, Limthongkul W. Indirect effects on adjacent segments after minimally invasive transforaminal lumbar interbody fusion [published online ahead of print, 2022 Aug 24]. World Neurosurg. 2022;S1878-8750(22)01197-4. doi:10.1016/j.wneu.2022.08.087 Potential risks and complications include, but are not limited to:

  • General anesthesia risks. When under general anesthesia, the patient may be using a breathing tube and a catheter. The anesthesia may have side effects that fade over time, such as dizziness, nausea and vomiting, or shivering. The use of associated devices poses additional risks, such as infection or sore throat.
  • Infection. As with any surgery, there is a risk of infection at the surgical site. Infection may be due to the use of medical tools and devices during surgery. During the hospital stay following the procedure, the patient is monitored for any signs of infection. Obesity, diabetes, and smoking are important risk factors for post-surgical infection.
  • Excessive blood loss. While patients can donate blood in advance of the surgery and can receive a blood transfusion during or after surgery, excessive blood loss is still an important risk to consider. For example, individuals who are taking blood-thinning medications may not be cleared for surgery because of the potential risk.
  • Nerve injury. Although TLIF is designed to reduce nerve irritation, like any spinal surgery, it is still possible that the nerves can be damaged during surgery. The risk arises from the process of accessing the spinal canal, decompressing nerve roots, removing disc material, placing the interbody devices, and/or pulling nerves aside.
Posterior view of the lumbar spine and the lumbar spinal nerves and spinal cord.

Injury to the spinal nerves and/or spinal cord in the lower back during a TLIF surgery may cause pain, numbness, and/or weakness along one or both legs.

  • Lack of a solid fusion. Also known as pseudoarthrosis, this risk is common in all spinal fusion surgeries. A failed fusion may be corrected with a second surgery.
  • Continued lower back pain. If the surgery fails, lower back pain may persist, or a new onset of lower back pain may develop. The risk of new back pain is generally greater in open TLIF than in minimally invasive TLIF. 5 Teng I, Han J, Phan K, Mobbs R. A meta-analysis comparing ALIF, PLIF, TLIF and LLIF. J Clin Neurosci. 2017;44:11-17. doi:10.1016/j.jocn.2017.06.013
  • Paraspinal iatrogenic injury. The paraspinal muscles (muscles surrounding the spine) are pulled aside during surgery. When these muscles are kept aside for a prolonged period of time, there is an increased risk of injury to these muscle groups. If injured, the paraspinal muscles may be a continued source of back pain regardless of whether or not the spinal fusion was successful.
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Additional medical complications from surgery can include pneumonia or circulatory problems, such as heart attack, stroke, or blood clots. Risks and complications may increase if the patient undergoing surgery is obese. 11 Othman YA, Alhammoud A, Aldahamsheh O, Vaishnav AS, Gang CH, Qureshi SA. Minimally Invasive Spine Lumbar Surgery in Obese Patients: A Systematic Review and Meta-Analysis. HSS J. 2020;16(2):168-176. doi:10.1007/s11420-019-09735-6 Minimally invasive approaches to TLIF aim to reduce blood loss, hospital stay, and risk of injury associated with open spine surgery. 12 Tan JH, Liu G, Ng R, Kumar N, Wong HK, Liu G. Is MIS-TLIF superior to open TLIF in obese patients?: A systematic review and meta-analysis. Eur Spine J. 2018;27(8):1877-1886. doi:10.1007/s00586-018-5630-0

While serious complications are uncommon, there is no guarantee that spinal fusion will be completely successful after TLIF. It is important to review the patient’s symptoms and diagnostic study results with the surgeon to ensure that TLIF is the surgery of choice for the condition being treated.

Read more about Spine Fusion Risks and Complications

  • 1 Hozumi T, Orita S, Inage K, et al. Successful salvage surgery for failed transforaminal lumbosacral interbody fusion using the anterior transperitoneal approach. Clin Case Rep. 2016;4(5):477-480. Published 2016 Mar 29. doi:10.1002/ccr3.553
  • 2 de Kunder SL, van Kuijk SMJ, Rijkers K, et al. Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J. 2017;17(11):1712-1721. doi:10.1016/j.spinee.2017.06.018
  • 3 Fleege C, Rickert M, Rauschmann M. PLIF- und TLIF-Verfahren. Indikation, Technik, Vor- und Nachteile [The PLIF and TLIF techniques. Indication, technique, advantages, and disadvantages]. Orthopade. 2015;44(2):114-123. doi:10.1007/s00132-014-3065-9
  • 4 Singhatanadgige W, Suranaowarat P, Jaruprat P, Kerr S, Tanasansomboon T, Limthongkul W. Indirect effects on adjacent segments after minimally invasive transforaminal lumbar interbody fusion [published online ahead of print, 2022 Aug 24]. World Neurosurg. 2022;S1878-8750(22)01197-4. doi:10.1016/j.wneu.2022.08.087
  • 5 Teng I, Han J, Phan K, Mobbs R. A meta-analysis comparing ALIF, PLIF, TLIF and LLIF. J Clin Neurosci. 2017;44:11-17. doi:10.1016/j.jocn.2017.06.013
  • 6 Epstein NE. Lower complication and reoperation rates for laminectomy rather than MI TLIF/other fusions for degenerative lumbar disease/spondylolisthesis: A review. Surg Neurol Int. 2018;9:55. Published 2018 Mar 7. doi:10.4103/sni.sni_26_18
  • 7 de Kunder SL, van Kuijk SMJ, Rijkers K, et al. Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J. 2017;17(11):1712-1721. doi:10.1016/j.spinee.2017.06.018
  • 8 Kim CH, Easley K, Lee JS, et al. Comparison of Minimally Invasive Versus Open Transforaminal Interbody Lumbar Fusion. Global Spine J. 2020;10(2 Suppl):143S-150S. doi:10.1177/2192568219882344
  • 9 Lim JBT, Yeo W, Chen JLT. Preoperative Leg Pain Score Predicts Patient Satisfaction After Transforaminal Lumbar Interbody Fusion Surgery. Global Spine J. 2018;8(4):354-358. doi:10.1177/2192568217723888
  • 10 Wasinpongwanich K, Nopsopon T, Pongpirul K. Surgical Treatments for Lumbar Spine Diseases (TLIF vs. Other Surgical Techniques): A Systematic Review and Meta-Analysis. Front Surg. 2022;9:829469. Published 2022 Mar 14. doi:10.3389/fsurg.2022.829469
  • 11 Othman YA, Alhammoud A, Aldahamsheh O, Vaishnav AS, Gang CH, Qureshi SA. Minimally Invasive Spine Lumbar Surgery in Obese Patients: A Systematic Review and Meta-Analysis. HSS J. 2020;16(2):168-176. doi:10.1007/s11420-019-09735-6
  • 12 Tan JH, Liu G, Ng R, Kumar N, Wong HK, Liu G. Is MIS-TLIF superior to open TLIF in obese patients?: A systematic review and meta-analysis. Eur Spine J. 2018;27(8):1877-1886. doi:10.1007/s00586-018-5630-0
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