TLIF Surgery Cost in India

Last Modified: July 21, 2020  |   Created on: March 4, 2020
Spine

“The cost of  TLIF surgery in India starts from USD 5000. The spine surgery hospitals in India promise unparalleled quality of treatment at low-cost packages.

How much does TLIF surgery cost in India?

The cost of TLIF surgery in India ranges from USD 5000 to USD 7500, depending on multiple factors. The TLIF surgery cost in India is relatively lower than several other countries of the world, but with equally good success rate and quality of medical care services.

One of the important factors that contributes to the cost of Transforaminal Lumbar Interbody Fusion surgery in India is the technique used (open or minimally invasive spine surgery) and the levels of spine fused. Other factors that may affect the overall cost are:

  • Location of the hospital
  • Quality standard of the hospital
  • Surgeon’s experience
  • Days of hospitalization
  • Room category
TLIF Surgery

What is TLIF surgery?

Transforaminal lumbar interbody fusion (TLIF) is a surgical procedure which is generally used to treat spinal disc problems which are causing back and leg pain. In this procedure, an intervertebral disc is removed and two or more bones in the anterior and posterior spinal columns are fused together using screws and a cage. The surgeon accesses the spine through small incisions made near the centre of the back and places a bone graft along with an interbody spacer (a supportive device or cage placed between the vertebral bones to retain intervertebral height). TLIF is a type of spinal fusion surgery that typically involves:

  • Removing the bone spurs (outgrowth of the bone in the spine) and ligaments to decompress the nerves in lower back
  • Removing the problematic intervertebral disc
  • Filling the space with a spacer bone graft (interbody fusion) – this helps restore the height between the bones and relieves pinched nerves
  • Stabilizing the disc level by placing screws (pedicle screws) into the bones above and below the disc – this also helps strengthen the graft.

Fusion can be one-level (joins two bones) or multi-level (joins three bones) depending on the symptoms. As the person heals, the bone grows around the graft and fuses the two vertebrae in the spinal column into one piece of bone. This effectively stops all the motion in the painful area of the spine, improving overall function and allows the person to have a more normal lifestyle. Although flexibility is decreased after TLIF, it doesn’t significantly affect most people.

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TLIF Surgery in India

India is one of the most popular countries when it comes to advanced medical procedures and sophisticated surgical techniques. A number of patients from different parts of the world travel to India for spinal fusion surgeries such as TLIF, Posterior lumbar interbody fusion (PLIF), Lateral lumbar interbody fusion, OLIF and Anterior lumbar interbody fusion (ALIF). The advanced healthcare setup at the top hospitals in India is supported by ultra-modern infrastructure and world’s latest instruments. These hospitals are accredited by various international and national quality control associations such as JCI and NABH for their high standard of patient services and safety management.

Spine surgery hospitals in India are equipped with the cutting edge technology for the most updated surgical techniques such as minimally invasive surgery. The modular operation theatres at these hospitals ensure maximum infection control protocols are used and have digital patient monitoring software.

India is home to some highly reputed spine surgeons who are recognized worldwide for their outstanding work in the field of medicine. The best spine surgeons in India are internationally trained professionals with several years of experience in treating various kinds of spinal problems. They are widely known for their skills and knowledge, and remain up-to-date with the recent developments in the area of surgery and advanced medical techniques. The surgeons are highly proficient in performing minimally invasive TLIF and have an excellent record of positive outcomes.

Why is it needed?

TLIF may help certain people with following spinal conditions:

  • Degenerative Disc: With age, the disc begins to dry and shrink. The thinning or herniation of the disc causes the vertebrae bones to rub and pinch the nerves. This results in significant back pain.
  • Spinal stenosis: In stenosis, the spinal canal and nerve root canals become narrow. Also, the pressure on the spinal nerves and instability of the spine can cause pain and numbness in the legs. The spinal stenosis can be of different types – Lumbar canal and/or lateral recess stenosis and cervical stenosis (Foraminal stenosis).
  • Spondylolisthesis: In this condition, the vertebrae bone slips forward out of its normal position onto the bone below it. It can then compress the nerves and cause pain.
  • Scoliosis: It is an abnormal curvature in the spine that is caused by improper alignment of the bones. This may occur due to aging discs, or arthritis, or a previous spine surgery, especially in adult patients.
  • Discogenic lower back pain: Back pain caused by a disc problem
  • Facet joint pain: (arthritis type condition of the spine) which do not improve with other treatment options such as facet joint blocks and radiofrequency denervations.

How can Lyfboat assist you getting TLIF Surgery in India?

World's Most Trusted Medical Advisory & Discount Platform

Lyfboat is a free advisory platform; we do not charge any fees from patients. In fact, we negotiate the price that Indian hospitals offer. In some cases we are able to reduce the cost by negotiating upto 20% of what Hospitals generally offer. We advise the best treatment from the top hospital/surgeon at best price.

Advantages of TLIF over other alternatives

TLIF procedure has many advantages over posterior and other spinal fusion techniques. It allows the surgeon to restore the correct intervertebral height (between the vertebrae) with less damage to the muscles and minimal manipulation of spinal nerves during the operation. It also reduces the degeneration and instability of the spine caused by the disease. The surgery aims to enhance the natural spinal curvature by helping it maintain the spinal column height and spinal fixation with instruments such as cages, rods, screws.

Also, this technique provides a larger surface area for fusion, which in turn increases the chances of a successful fusion. With TILF, the surgeon can directly address and work on the impacted part in the front of the spinal column.

What are the diagnostic tests required before TLIF?

The doctor recommends TLIF procedure after a thorough medical examination to determine the suitability of the patient for this surgery. They usually take a full medical history of the patient and conduct various neurological tests. Medical history including the symptoms and problems the patient is suffering from is the most important part of the assessment. Some imaging tests recommended by the doctor to analyse the problem include:

  • CT scan – to check the anatomy of the bone and joints
  • MRI scan – to have a more detailed visuals of the discs and nerves
  • CT Myelogram – usually required when an MRI cannot be performed due to some reason
  • Standing X-rays and X-rays – also called flexion-extension X-rays as they are taken while bending forward and backward to check for spondylolisthesis and spine instability
  • Nerve conduction test and/or a nerve sheath injection using local anaeasthetic
  • to confirm the nerve or nerves are causing the pain and other symptoms
  • Facet joint blocks with or without a nuclear medicine scan (lumbar SPECT) in case it is suspected that pain is arising from the facet joints
  • Provocative lumbar discogram – used when pain is suspected to be caused by an intervertebral disc
  • Nuclear medicine bone scan – to check for cancer of the spine
  • DEXA scan (Bone density scan) to check for osteoporosis

What happens during the surgery?

The surgery can be performed through a traditional open incision or a minimally invasive procedure. In most cases now, minimally invasive surgery is preferred as it causes less post-operative discomfort and faster recovery. The procedure is performed under general anaesthesia so that the patient is asleep and feels no pain during the operation.

  • For a Transforaminal lumbar interbody fusion surgery, the patient lies face down as the surgery is performed through an incision made on the back. The surgeon makes small incisions depending on the specific disc that is affected and how many levels are to be treated.
  • Through the incision, the surgeon can access the spine and the damaged disc that is to be treated. A portion of facet joint and bony lamina is removed along with bone spurs and ligaments, which leads to decompression of nerves. Then the disc nucleus is carefully taken out. A portion of the disc wall is deliberately left behind to help with placement of the bone graft material.
  • As the disc space is cleared out, the surgeon prepares the bone surfaces or resurfaces the bone for fusion using bone shavers and other tools. The open space is measured and a spacer graft is selected accordingly.
  • The bone graft is prepared for fusion and is then placed in the disc space between the two vertebrae bones. It is inserted in the disc space, which pushes the bones and restores the normal disc height.
  • When the fusion is complete, the vertebrae will be a single piece of bone that moves as one unit. In rare cases, the bones may not fuse as planned and this condition is known as a nonunion, or pseudarthrosis.
  • After the fusion step, the surgeon inserts pedicle screws into the bone for fixation and stability. It involves enlarging the opening around the spinal nerves and working beneath the exiting nerve through the neural foramen, hence the term “transforaminal” is used for this surgery.
  • Finally, a rod is placed between the screws to connect them and maximize their stability. This allows the lumbar level to be stable while fusion occurs. The surgeon also places an additional bone graft material along the back of the spine to provide more area for spine fusion.
  • The incision is then closed using sutures or surgical glue.

How is the recovery after TLIF surgery?

The patient is shifted to a recovery room after the surgery where the doctors and nurses will monitor the heart and other vital body functions. The patient may stay in the hospital for 2 to 4 days depending on their age, severity of damage to the spine and the extent of surgery.

The patient is generally encouraged to get out of the bed and move around the next day, as soon as they feel better. After discharge, the patient will need to follow all instructions and precautions given by the doctor. The physical therapy program will continue after getting home to help strengthen the muscles.

The patient may have to wear a special brace for 3 months following the surgery while sitting, standing or walking. It is advised to take it easy for 8 weeks and avoid any strenuous activities, but walk for at least an hour every day. It is also recommended to not sit at a place for more than 15-20 minutes continuously during this period.

The recovery time varies for every individual but it usually takes around 3 months or more to heal from the surgery. However, this amount of time is different for every patient and depends on multiple factors such as their healing speed, technique used for surgery and overall health of the patient.

The bone graft or substitute that is placed in the spine during the surgery facilitates bone growth between the two adjacent vertebrae to fuse into one bone. This process usually takes about 3 to 6 months. The bone continues to facilitate growth and solidify over the 12 to 18 months post surgery. Most people return to normal activities including the more physical ones such as weightlifting in about 6 months after the surgery.

What are the risks and complications of TLIF surgery?

General risks that are associated with all kinds of surgery such as infection, bleeding, blood clots, and reactions to anaesthesia are applicable in TLIF as well. Some complications that are specifically related to TLIF include:

Failure of fusion:

Sometimes, bones may not fuse over time. Many factors contribute to this, such as smoking, alcohol consumption, medical conditions including osteoporosis, obesity, diabetes, and malnutrition. If the fusion does not take place (known as pseudoarthrosis), the patient may require another surgery for repair.

Transitional syndrome:

Spinal fusion may lead to transfer of additional stress and load to the discs and bones above/below the segment fused. This added stress may eventually cause degeneration of the adjacent discs and result in pain.

Persistent pain or Nerve damage:

All spinal surgeries include the risk of injury to the nerves or spinal cord. Damage to the nerves can lead to numbness or paralysis. Most often, the cause of persistent pain is nerve damage caused by the disc herniation itself and if the damage is permanent, the nerve will not respond to surgical decompression. In such cases, spinal cord stimulation or other treatments may provide relief.

Hardware fracture:

Metal screws that are used to stabilize the spine graft and disc may move or break before complete fusion of the bones. This may require another surgery to fix or replace the screws. Symptoms suggesting a broken hardware include – sudden sharp pain the back (in the operated area), numbness or tingling feeling in legs and shoulders, and return of other symptoms that the patient had before the surgery. You should contact your doctor as soon you start noticing these signs.

Bone graft migration and settling:

In some rare cases, the bone graft moves from the position it was placed soon after surgery. This usually occurs when the plates and screws are not used or fusion was performed for many vertebral levels. With time, the bone graft spacer can possibly sink into the bone (called as subsidence) and decrease the indirect decompression of the nerves. If this occurs, another surgery may be required to repair or correct the problem.

Frequently asked Questions (FAQs) TLIF Surgery in India

Q. How is TLIF different from PLIF?

TLIF and PLIF are both posterior approach spine surgeries, i.e. from the back side. For Posterior Lumbar Interbody Fusion (PLIF), the surgeon accesses the spine from the middle or centre line of the vertebral column while for TLIF, the incision is made slightly towards one of the sides (unilateral access).

Q. When can I resume work after the surgery?

The duration of recovery is different for every person. Most people are able to return to a desk job in about 4 to 6 weeks. It may take 12 weeks to get back to more physically demanding activities.

Q. When will I be able to drive myself after spine fusion surgery?

Driving can be generally resumed in about two weeks or more after the surgery if the person is off the opioid medications. The doctor will analyse the healing of the spine and advise you the right time to begin driving.

Q. Who is a suitable candidate for TLIF?

A person is a candidate for TLIF if they have degenerative disc disease, spondylolisthesis and mild to moderate scoliosis and their symptoms have not improved with other non-invasive approaches such as physical therapy or medication. Some people are not suitable to have TLIF if they have:

  • severe osteoporosis condition
  • Prior fusion surgery for that level
  • Problems that would not allow proper bone fusion

Q. Who performs the surgery?

A team of surgeons including neurosurgeon or orthopedic surgeon may perform the spine surgery. Several spine surgeons undergo specialized training to perform minimally invasive surgery. TLIF is a complex surgical procedure and requires excellent training and skills of the surgeon for successful results. Read the article for the best spine surgeons in India to know more about the doctors qualifications and experience.

Q. What are the factors that can affect or slow recovery post-surgery?

The healing and fusion of bones may take longer than the typically required 3 to 6 months if patients:

  • Smoke or use nicotine products (toxins that affects the bone growth)
  • Obesity and diabetes
  • Osteoporosis
  • Malnutrition
  • Long-standing use of opioids before surgery
  • Prednisone medication
Vanshika Rawat

Written By Vanshika Rawat

Vanshika Rawat is an experienced content developer. She is very knowledgeable in the field of science and healthcare and has worked under brilliant scientists during her higher education. Vanshika obtained her degrees in Masters in Science and Bachelors in Science (Microbiology with Hons.) from renowned institutions - Panjab University and University of Delhi.

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