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I am going to have spinal surgery over the Christmas break. It's only one level (L45) and the surgeon is using a method she calls TLIF. She assures me I'll be in and out of the hospital in less than 24 hours if all goes well. Can you tell me more about what to expect and how to know if I'm going to make it out that fast?

For almost 30 years surgeons have been fusing the lumbar spine using the popular transforaminal lumbar interbody fusion (TLIF) technique. The surgeon approaches the spine from the side rather than from the front (anterior approach) or the back (posterior approach). The TLIF method of lumbar fusion has many advantages. The lateral approach gives the surgeon access to the disc and disc space without applying excess pull or traction on the nearby spinal nerve(s). With a lateral approach, it is only necessary to remove one spinal joint (rather than the joints on both sides of the spinal level being fused) in order to get to the disc space. The procedure can be done now as a minimally invasive (MI) approach. Minimally invasive means a very small incision is made. With minimally invasive surgery, there is usually less blood loss during the procedure and postoperative pain afterwards. Hospital stays are shorter with the mTLIF, which means lower costs. Other advantages of the minimally invasive approach have been reported. For example, there is less damage to the muscles and less tissue trauma overall. The surgeon uses 3-D navigational (surgical) tools that allow him or her to see the correct pathway and avoid injury to nerve tissue. The end-result is a faster recovery time, fewer complications, and shorter hospital stays. Most patients are indeed able to go home in less than 24-hours. You will probably work with a physical therapist after surgery. You will be discharged when you can walk at least 100 feet and manage a dozen or so stairs on your own. If you can do these two things, then it's likely you are safe and independent enough to manage at home. Secondly, you will have to have nursing clearance based on your pain control and tolerance of the pain meds. Problems after surgery can develop once you are home. The surgical team will make sure you (and a family member) are well aware of what to watch out for (e.g., infection, bleeding, blood clots). Any sign of such complications must be reported to the surgeon's office. But most of the time, as your surgeon has indicated, all will go well and you will be in and out in less than a day.

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