Minimally Invasive Surgery

Transforaminal Lumbar Interbody Fusion (TLIF)

Stabilizing the Spine and Relieving Nerve Compression

Transforaminal Lumbar Interbody Fusion (TLIF) is a spinal fusion procedure performed through a posterior approach to the spine. It relieves nerve pressure by removing a damaged disc and stabilizing the motion segment with bone graft and implants. At Desert Spine and Pain, neurosurgeon Dr. David L. Greenwald, M.D., FAANS, FACS specializes in minimally invasive TLIF (MIS-TLIF), which uses small incisions and tubular retractors to reduce muscle damage and speed recovery compared to traditional open fusion.

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Over 30 Years Experience in Orthopedic & Neuro Spine Surgeries.

What Is TLIF?

  • In simple terms: We make a small incision in the back, remove the disc causing nerve compression, place a cage filled with bone graft between the vertebrae, and stabilize with screws and rods so the bones fuse together.

  • Scientifically: TLIF uses a unilateral posterior transforaminal corridor. A facetectomy creates access to the disc space. After discectomy and endplate preparation, an interbody cage with graft is inserted diagonally across the disc space. Pedicle screw/rod fixation is applied bilaterally to provide immediate stability and enhance fusion.

Conditions Treated

  • Spondylolisthesis (slipped vertebra)

  • Degenerative disc disease with instability or collapse

  • Spinal stenosis with instability

  • Recurrent herniated discs after prior surgery

  • Traumatic instability or deformity correction in the lumbar spine

Pre-Operative Preparation

  • MRI and CT scans to confirm diagnosis and surgical level

  • Flexion/extension X-rays to evaluate instability

  • Medical optimization (smoking cessation, diabetes/bone health management)

  • Physical therapy before surgery to improve recovery

  • Pre-op counseling on recovery timelines and restrictions

The TLIF Procedure: Step by Step

Plain-English Overview

  1. Anesthesia & positioning: You’re asleep under general anesthesia, lying face down.

  2. Small incision: One or two small incisions are made in the lower back.

  3. Muscle-sparing approach: Tubular retractors gently separate muscles.

  4. Facet removal: A portion of the facet joint is removed to create a corridor.

  5. Disc removal: The damaged disc is removed, and bone surfaces are cleaned.

  6. Cage placement: A cage filled with bone graft is inserted into the disc space to restore height and relieve nerve pressure.

  7. Screws & rods: Pedicle screws and rods stabilize the segment.

  8. Closure: The incision is closed; most patients walk the same day or next.


Surgeon-Level Detail

  • Exposure: Paramedian MIS incision; tubular retractor system docked over facet.

  • Facetectomy: Unilateral facetectomy performed with drill and Kerrison punches.

  • Discectomy: Annulotomy; disc removed with pituitaries/curettes; meticulous endplate preparation preserving cortical bone.

  • Interbody cage: Trial sizing; lordotic cage packed with autograft/allograft placed diagonally across disc space.

  • Pedicle screw fixation: Bilateral percutaneous screws and rods placed under fluoroscopic navigation.

  • Final check: Fluoroscopy confirms implant position; wound irrigated and closed.

Benefits of TLIF

  • Minimally invasive = less pain, smaller incision, quicker recovery

  • Provides both direct decompression (nerve freed) and stabilization (fusion)

  • Restores disc height and foraminal space

  • High fusion success rates with modern implants and biologics

  • Outpatient or short hospital stay possible for many patients

Risks & Limitations

  • Infection, bleeding, nerve injury, dural tear (CSF leak)

  • Hardware failure or non-union (fusion not taking)

  • Persistent back pain in some cases

  • Adjacent segment disease (wear above/below fused level) over time

Recovery Timeline

  • Day 0–1: Walking within hours; hospital stay 1–2 nights for most

  • Weeks 1–2: Light activity at home; incision healing

  • Weeks 2–6: Many return to desk work; start gentle PT

  • 6–12 weeks: Gradual increase in activity; restrictions easing

  • 3–6 months: Most patients resume normal activities; fusion consolidates

  • 6–12+ months: Complete bone fusion; clearance for heavy work/sports

Why Choose Desert Spine and Pain?

  • Expert neurosurgeon: Dr. Greenwald has extensive experience in TLIF and MIS techniques

  • Conservative-first approach: Surgery only after PT, medications, and injections have been tried

  • Advanced MIS tools: Navigation, tubular retractors, neuromonitoring for safety and accuracy

  • Compassionate guidance: Patients receive clear education and ongoing support throughout recovery

Frequently Asked Questions

How is TLIF different from PLIF?

TLIF uses a unilateral corridor, removing less bone and reducing nerve manipulation compared to PLIF (posterior lumbar interbody fusion).

How soon can I return to work?

Desk jobs often at 2–4 weeks; heavy labor usually 3–6 months depending on healing.

Will I need a brace?

Sometimes for short-term support, depending on stability and bone quality.

Does TLIF cure back pain?

It’s best for patients with nerve compression plus instability. It relieves leg pain reliably and may improve back pain, but outcomes depend on the cause.

How does Desert Spine and Pain approach TLIF differently?

We use neurosurgical precision, MIS technology, and a conservative-first philosophy to ensure surgery is both safe and effective.

Dr. David L. Greenwald, MD

Neuro-Spine Surgeon

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If you’re suffering from persistent lower back or leg pain due to spinal instability or nerve compression, Transforaminal Lumbar Interbody Fusion (TLIF) may provide the lasting relief you need. Dr. Greenwald and his experienced team will conduct a thorough evaluation to determine whether this advanced, minimally invasive procedure is right for you. Every step you take toward recovery brings you closer to comfort, strength, and renewed quality of life. Schedule your consultation today and discover how Dr. Greenwald’s expertise in TLIF can help you return to a pain-free, active lifestyle.

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Over 30 Years Experience in Orthopedic & Neuro Spine Surgeries.

Dr. David L. Greenwald, M.D., F.A.C.S.

Neurosurgeon | Spine Surgeon | Regenerative Medicine

Dr. David L. Greenwald, MD, FACS, is a board-certified spine surgeon specializing in Transforaminal Lumbar Interbody Fusion (TLIF), a minimally invasive surgical procedure used to stabilize the spine and relieve nerve compression in the lower back. TLIF is commonly performed to treat conditions such as degenerative disc disease, spondylolisthesis, and spinal stenosis. Using a single small incision and image-guided technology, Dr. Greenwald accesses the spine through the natural corridor of the foramen—reducing muscle disruption and promoting faster recovery. His meticulous technique allows for precise removal of damaged disc material, placement of bone grafts, and stabilization with implants, helping patients throughout South Florida experience long-term pain relief, restored stability, and improved mobility.

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