What it is
A transforaminal lumbar interbody fusion performed through small incisions. The nerves are decompressed, the disc is removed and replaced with a cage packed with graft, and screws and rods hold the level while it fuses — all with muscle-sparing access rather than a long midline dissection.
Who it is for
Spondylolisthesis with nerve compression, instability on flexion and extension films, recurrent stenosis at a previously decompressed level, and selected revision cases. It treats leg symptoms from compression and the instability driving them; it is less predictable for back pain alone.
How it works
Through two small paramedian incisions, screws are placed into the pedicles under X-ray guidance. On the symptomatic side, a tubular retractor gives access to decompress the nerve root and remove the disc. The space is prepared and a cage with bone graft is inserted to restore height and provide a surface for fusion. Rods connect the screws and compress the construct.
Recovery
Usually one to two nights in hospital. Walking the same day or the next. Desk work commonly at four to six weeks, heavier work three months or more. Bracing is not routine. Fusion consolidates over three to six months.
Risks and alternatives
Dural tear, nerve injury, infection, bleeding, screw malposition, cage settling, failure of fusion — more likely in smokers and in poor bone — and adjacent level degeneration over the years. Alternatives are decompression alone where the level is stable, open fusion, an anterior or lateral approach, or continued non-operative care.