Transforaminal Lumbar Interbody Fusion Surgery in Singapore

Thorough preparation is essential for TLIF. In the weeks before surgery, you will undergo:

Medical Evaluation

• Comprehensive blood tests
• Cardiac evaluation if you have heart conditions or risk factors
• Chest X-ray to ensure lung health for general anaesthesia
• Updated MRI or CT scan of your lumbar spine

Pre-Operative Requirements

• Smoking cessation well in advance, as smoking significantly impairs bone healing
• Stopping certain medications such as blood thinners and anti-inflammatory drugs as directed
• Optimising blood sugar control if you have diabetes
• Nutritional assessment and optimisation if needed

Day Before Surgery

• Avoid eating or drinking after midnight
• Shower with antiseptic soap as instructed
• Prepare your home for recovery, including setting up a comfortable resting area

On the day of surgery, you will arrive at the hospital several hours before your scheduled procedure time.

Anaesthesia and Positioning

You will receive general anaesthesia, meaning you’ll be completely asleep throughout the surgery. Once anaesthetised, you’ll be carefully positioned face-down on a specialised surgical table that supports your body whilst allowing access to your lower back.

Surgical Steps

The surgery typically takes a few hours, depending on the number of levels treated and case complexity:

1. The surgeon makes an incision over the affected spinal level(s)
2. Muscles are carefully moved aside to expose the posterior spine
3. A portion of the lamina (bony arch at the back of the vertebra) and facet joint is removed to access the disc space
4. The damaged disc material is completely removed
5. The endplates (bone surfaces where the disc attaches) of adjacent vertebrae are prepared to receive the graft
6. An interbody cage filled with bone graft is inserted into the disc space
7. Pedicle screws are placed into the vertebrae above and below the fusion level
8. Rods connect the screws to provide immediate stability
9. An additional bone graft is placed along the posterolateral spine
10. The wound is closed in layers

Intraoperative Monitoring

Throughout the procedure, neuromonitoring tracks the function of your spinal cord and nerve roots, allowing the surgical team to detect any changes and take immediate corrective action if needed.

Following your TLIF surgery, medical staff will transfer you to the recovery room to monitor your vital signs and pain levels as the anaesthesia wears off.

Recovery Room

• Monitoring of blood pressure, heart rate, and oxygen levels
• Assessment of sensation and movement in your legs
• Initial pain management with intravenous medications
• Gradual awakening over a couple of hours

First Day in Hospital

• Transfer to your hospital room once stable
• Beginning of pain medication regimen
• Possible use of a patient-controlled analgesia (PCA) pump (a device that lets you give yourself controlled doses of pain medication)
• First attempts at sitting up and potentially standing with assistance
• Deep breathing exercises to prevent lung complications

Hospital Stay

Patients typically remain in the hospital for a few days following TLIF surgery. During this time, physiotherapists will guide you through safe movement techniques and walking. You’ll receive instructions on wound care, activity restrictions, and signs of complications to watch for at home.