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Almost every person may face back pain problems at some point of time in their lifetime. Back pain can be caused due to a lot of problems, such as overuse, such as working out or lifting heavy weights, sitting for a long time or lying down, improper sleeping position, wearing high heels, or wearing an uncomfortable backpack. Some other underlying conditions that might result in lower back pain are spondylolisthesis, degenerative disc disease, musculoskeletal disorder, lumbar (segmental) Instability, etc.

Lower Back Pain And Lumbar Instability

Lower back pain is defined as pain or discomfort that occurs in the lumbar region of the spine. In nearly 85% of patients suffering from lower back problems, the pain is non-specific; i.e., there are no specific medical procedures to diagnose the reason for the pain. People having weak muscle strength and resistance are more prone to low back pain. Some studies suggest that overweight people are also at risk of chronic low back pain, but there is no clinical evidence.

Lumbar (segmental) instability often results in low back pain. Lumbar Instability falls under a non-specific low back pain group. Instability is associated with pain caused due to functional disability and reduced muscle strength. Patients with lumbar Instability may suffer from spinal motion segment stiffness, which might cause pain, spinal deformity, or damage to the neurological structures.

Causes Of Spinal Instability

Lumbar Instability is also termed Spinal Instability, a condition that happens when the intervertebral discs begin to degenerate. The bulge of the intervertebral disc reduces the disc and starts to lose height.

Other causes could be:-

  • External trauma to the spine
  • Formation of metastatic tumours in the spine or infections which cause loss of vertebral height.
  • Degenerative disease of the spinal discs
  • Spinal conditions like scoliosis and spondylolisthesis
  • Connective tissues disorders
  • Poor lifting techniques


  • You may suffer from severe back pain during lifting objects, bending or while resting or turning in the bed
  • A feeling of locking up while doing physical activities
  • Muscle spasms
  • Chronic pain that radiates from the back down into the legs and buttocks that usually affects one side of the body
  • A feeling of numbness in the lower body parts and arms
  • The symptoms might flare up after sitting or standing for a long time or unaccustomed exertion
  • Pain might flare up even while laughing, coughing or sneezing

Treatment For Lower Back Pain Due Lumbar Instability

In the case of mild Spinal Instability, Physical therapy is effective enough to treat as it focuses on improving the strength of the spinal muscles. Painkillers and anti-inflammatory medications are also suggested in some cases. However, when the first line of treatment procedures do not work, surgical procedures are inevitable to treat such conditions. Microdiscectomy is a surgical procedure that removes the intervertebral disc affecting the spinal nerve. Spinal Fusion is another surgical procedure that fuses two or more spinal vertebrae to improve spinal stability.

Transforaminal Lumbar Interbody Fusion (TLIF) For Lower Back Pain Due To Lumbar Instability

TLIF is a modern approach to perform spinal fusion surgery. It is a procedure performed to remove an intervertebral disc in the lower back and fuses two or more vertebrae(spinal bones) together and is stabilized with the help of screws and a cage.

A TLIF procedure involves:-

  • Decompressing the nerves causing lower back pain
  • Partial  Excision of the facet joint
  • Removing the damaged intervertebral disc
  • Stabilizing the disc with the help of screws inserting into the bones above and below
  • Fusing of the vertebrae in the spine by inserting a cage called interbody Fusion

A TLIF is more advantageous compared to (PLIF) posterior lumbar interbody fusion and posterolateral instrumented fusion surgical techniques.

TLIF Procedure explained:-

The patient will be placed on the operating table by keeping your face-down on a special spinal frame or bolsters. The incision site will be cleaned with an antiseptic solution, and local anesthesia will be given. A vertical incision about 6-10cm is made in the lower back at the site of the incision. The surgeon removes a portion of bone and a lamina joint, facet joints at the back and side of the vertebra. Partial or complete facetectomy is performed, and the nerve roots are decompressed.

This bony removal relieves pressure on the spinal cord nerves, and it also helps the surgeon to access the vertebral disc. Disc removal is performed by cutting down the outer annulus fibrosis around the disc, and the nucleus pulpous is removed.

The surgeon places a supportive device called a spacer between the vertebral bodies to holds the vertebral space between like the disc. Sometimes a tricortical bone graft is placed instead of a cage. The boundaries of the vertebral disc space are carefully prepared for fusion. A mixture of tricalcium phosphate (synthetic bone graft and pulverized bone harvested from the patient is placed are inserted into the disc space in front of the cage.

Interbody cage is the most common spacer used; it is a small Titanium or PEEK material implant stuffed with bone graft. With the help of screws and rods, the surgeon joins the adjacent vertebrae to prevent movement. The instruments used (cage, screws, and rods) are meant to provide stability to the spinal column.

TLIF is a recent and innovative procedure that helps to treat lower back issues. The results of the surgery will be outstanding when it is performed by an experienced spine surgeon. Dr. Surya Prakash is one of the best spine surgeons in Hyderabad and has more than two decades of experience in performing TLIF and various other spine surgeries. For more information, make an appointment with the doctor right away.

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