Lumbar Fusion — Oklahoma City
TLIF Surgery in Oklahoma City
Transforaminal lumbar interbody fusion (TLIF) is a posterior approach to lumbar fusion that allows Dr. Blythe to decompress the nerve roots and place an interbody cage through a single, minimally disruptive incision.
What is TLIF?
TLIF — transforaminal lumbar interbody fusion — is a lumbar fusion technique performed entirely from the back of the spine. Through a posterior midline or minimally invasive paramedian incision, Dr. Blythe removes the disc, decompresses the affected nerve root through the foramen, and places an interbody cage packed with bone graft material to restore disc height and promote fusion.
Because the approach travels through the foramen on one side of the spine, TLIF avoids the bilateral muscle retraction required by older posterior techniques such as PLIF. The result is a single-stage procedure that simultaneously decompresses the neural elements and stabilizes the motion segment with pedicle screw fixation.
TLIF is one of the most commonly performed lumbar fusion procedures in the United States and is well-supported by long-term clinical data across a wide range of lumbar pathology.
Conditions treated with TLIF
- Degenerative disc disease with instability
- Spondylolisthesis (grade I and II)
- Recurrent disc herniation at a previously operated level
- Foraminal stenosis with radiculopathy
- Lumbar spinal stenosis with instability
- Adjacent segment disease following prior fusion
- Pseudarthrosis requiring revision fusion
Why the transforaminal approach?
The transforaminal corridor provides direct access to the disc space and the compressed nerve root from a single side, reducing the need to retract the thecal sac and both nerve roots as required by a posterior lumbar interbody fusion (PLIF). This translates to less neural manipulation and a lower risk of neurological complications.
The posterior approach also means TLIF can be performed without mobilizing major abdominal vessels, making it suitable for patients who are not candidates for anterior or lateral approaches due to prior abdominal surgery, obesity, or vascular anatomy.
Minimally invasive TLIF (MIS-TLIF)
Dr. Blythe performs TLIF using minimally invasive techniques whenever the anatomy and pathology allow. MIS-TLIF uses tubular retractors and fluoroscopic or navigation guidance to place pedicle screws and the interbody cage through small incisions, significantly reducing muscle damage compared to open posterior surgery.
Patients undergoing MIS-TLIF typically experience less postoperative pain, reduced blood loss, shorter hospital stays, and faster return to activity than those treated with traditional open TLIF. The fusion rates and long-term outcomes are equivalent to the open technique.
TLIF compared to ALIF, OLIF, and LLIF
TLIF, ALIF, OLIF, and LLIF are all interbody fusion techniques that differ primarily in the direction of approach to the disc space. TLIF approaches from the back through the foramen; ; ALIF from the front through a retroperitoneal corridor; OLIF through an oblique corridor anterior to the psoas; and LLIF directly through the lateral psoas muscle.
TLIF is the most versatile of the four because it can be performed at any lumbar level including L5-S1, does not require repositioning or a separate anterior team, and allows simultaneous decompression and fusion in a single posterior stage. ALIF and OLIF allow placement of a larger cage for greater disc height restoration but cannot directly decompress the neural elements. The optimal approach depends on the specific pathology, level, and patient anatomy.
Recovery after TLIF
Most patients undergoing MIS-TLIF are ambulatory the day of surgery and discharged within one to two days. Open TLIF typically requires a two to three day hospital stay. A structured physical therapy program begins within the first few weeks. Light activity resumes at four to six weeks; more demanding work or physical activity at three to six months depending on fusion progress confirmed by imaging.
Frequently asked questions about TLIF
- How is TLIF different from PLIF?
- Both TLIF and PLIF are posterior interbody fusion techniques, but TLIF approaches the disc through the foramen on one side, requiring retraction of only one nerve root. PLIF requires bilateral retraction of both nerve roots and the thecal sac to place cages on both sides of the disc. TLIF is associated with lower rates of nerve injury and dural tear compared to PLIF.
- Can TLIF be performed at L5-S1?
- Yes. TLIF is one of the few interbody fusion techniques that can reliably access the L5-S1 disc space, which is often inaccessible to lateral approaches due to the iliac crest. This makes TLIF a preferred technique for L5-S1 pathology when an anterior approach is not indicated.
- What type of implant is used in TLIF?
- Dr. Blythe uses PEEK (polyetheretherketone) or titanium interbody cages packed with autograft bone, allograft, or bone morphogenetic protein (BMP) depending on the clinical situation. Pedicle screws and rods are placed bilaterally to stabilize the segment while the fusion matures.
- How long does TLIF surgery take?
- A single-level MIS-TLIF typically takes two to three hours. Open TLIF or multi-level procedures may take three to five hours. The exact duration depends on the number of levels fused, the complexity of the decompression, and whether revision surgery is required.
- Will I need physical therapy after TLIF?
- Yes. Physical therapy is a standard part of recovery after TLIF. A therapist will guide you through core strengthening, posture training, and progressive activity advancement. Most patients complete a formal PT program over eight to twelve weeks, with continued home exercise thereafter.
Medically reviewed by Joseph R. Blythe, DO
Board-Certified Orthopedic Surgeon · Fellowship-Trained Spine Surgeon · Last reviewed: August 2026
Considering TLIF surgery in Oklahoma City?
Dr. Joseph Blythe evaluates each patient individually to determine whether TLIF, ALIF, OLIF, LLIF, or a non-surgical approach is the most appropriate treatment. Schedule a consultation to review your imaging and discuss your options.