To address this limitation, the TLIF approach is proposed, involving direct, unilateral access to the intervertebral foramen whilst reducing direct dissection and surgical trauma to spinal muscles and structural integrity.
The TLIF approach involves positioning the patient prone after the patient is put under general anesthesia. A midline or bilateral paramedian mini-open incision is used, allowing access to the disc space suitable for levels L1-S1.
e.g. Navigation allows safer procedure. (对比: Navigation makes procedure safer）
Prone: 俯卧位 Supine: 仰卧位
Lateral decubitus: 侧卧位 (decubitus就是卧的意思)
The spinal canal is entered via a unilateral laminectomy and inferior facetectomy, which facilitates bone graft placement.
Placement: 可以搭配screw，rod，cage等，也可以搭配bone graft
Indications of a TLIF approach include all degenerative pathologies, including broad-based disc prolapses, degenerate disc disease, recurrent disc herniation, pseudoarthrosis, and symptomatic spondylosis. Contraindications are similar to PLIF and include extensive epidural scaring, active infection and osteoporotic patients.
Advantages of the TLIF approach include relatively easier access to the posterior structures including the lamina, ligamentum flavum and facet joints. Compared to a traditional PLIF technique, the TLIF approach preserves ligamentous structures which are instrumental to restoring biomechanical stability of the segment and adjacent structures.
In TLIF, a single unilateral incision is able to provide bilateral anterior column support. Access using a MIS mini-open incision and magnification (loupes or microscope) may further reduce access-associated muscle injury, minimize bleeding and improve postoperative recovery.
The disadvantage is that TLIF, like PLIF, is associated with significant paraspinal iatrogenic injury with prolonged muscle retraction. It may be difficult to correct coronal imbalance and restore lordosis. Compared to anterior approaches, endplate preparation may be difficult.