TITLE:
Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Disease: A Comprehensive Review of Surgical Progression, Biomechanical Principles, and Graft Material Evolution
AUTHORS:
S. Ahmad Shuab Ghafoori, Ezatullah Hamdard, Mir Qareeb Urahman Mehrabi, Yu Yan
KEYWORDS:
TLIF, Degenerative Disc Disease, Lumbar Spondylolisthesis, Autologous Bone Graft, Bone Morphogenetic Protein, rhBMP-2, Bioactive Glass, AI-Assisted Imaging
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.14 No.4,
April
30,
2026
ABSTRACT: Background: Lumbar degenerative disease is a leading cause of chronic back pain, functional disability, and reduced quality of life worldwide. Transforaminal lumbar interbody fusion (TLIF), first described by Harms and Jeszenszky in 1982, has become a widely used surgical technique for managing degenerative lumbar conditions, including spondylolisthesis, spinal stenosis, recurrent disc herniation, and segmental instability. This review synthesizes current evidence on surgical evolution, biomechanical principles, graft materials, and emerging technological applications. Methods: A systematic literature search was conducted in PubMed/MEDLINE, Cochrane Library, EMBASE, and Google Scholar for studies published between 2000 and 2025, with inclusion of selected historical references. Approximately 300 articles were screened, and 80 were included based on relevance and quality. Study quality was assessed using Oxford CEBM and GRADE frameworks. Results: Current evidence indicates that TLIF achieves fusion rates of approximately 85% - 95% with acceptable complication profiles across both open and minimally invasive approaches. Autologous bone graft remains the reference standard due to its combined osteogenic, osteoinductive, and osteoconductive properties. Bone morphogenetic protein (BMP) demonstrates comparable fusion rates but is associated with higher cost and specific complications. Bioactive glass has been investigated as a synthetic alternative, with reported fusion rates ranging from 75% - 90%; however, evidence remains limited and heterogeneous, particularly in direct comparisons within TLIF procedures. Minimally invasive TLIF shows similar fusion outcomes to open techniques while reducing perioperative morbidity. Emerging technologies, including artificial intelligence and robotic navigation, are being explored for surgical planning and intraoperative guidance, though their clinical impact within TLIF remains under evaluation. Conclusions: TLIF is a well-established and effective surgical technique supported by substantial clinical evidence. However, important gaps remain, particularly regarding direct comparative effectiveness of graft materials in TLIF, long-term outcomes, and standardized patient selection criteria. While bioactive materials, artificial intelligence, and precision-based approaches represent promising areas of research, their roles in TLIF require further validation through high-quality comparative studies. Future research should emphasize randomized controlled trials, long-term follow-up, and robust evaluation of emerging technologies within clinical practice.