Lumbar Spine Fusion

How is it performed?

A lumbar spinal fusion is a surgical procedure used to fuse two or more vertebrae together to create a stable unit to limit movement of painful, damaged vertebrae. Because your lumbar spine needs to be accessed during a lumbar spinal fusion, an open procedure will be performed in which an incision several inches in length is made along the front, side, or back of your body to access the affected vertebrae. The disc between the affected vertebrae will be removed and replaced with a bone graft implant to maintain the proper height of your spine. The vertebrae and the implant will then fuse together over time.

Graft Decision

To create a bone graft, an implant called an interbody cage will be used to act as the framework. Interbody cages are most commonly made of titanium metal or a substance called polyetheretherketone (PEEK) that has similar properties to bone. 

The openings within the interbody cage are filled with grafted bone to complete the bone graft implant to replace a spinal disc and act as a spacer between the vertebrae that are being fused together. This bone can either be obtained from your own body or from a donor. Choosing between which type of graft to use will be a decision made by you and your surgeon. 

Autograft

An autograft is a graft obtained from your own body. Most commonly, a portion of bone is removed from the iliac crest, the upper rim of your hip bone. An autograft is the “gold standard” type of graft for lumbar spinal fusions due to the improved ability of your body to fuse its own bone cells together in order to heal. Because using an autograft requires additional surgery at your hip bone, you may experience additional pain at the graft site. Autografts are particularly beneficial for multilevel spinal fusions and tend to fuse vertebrae together faster than allografts.

Allograft

An allograft is a graft obtained from a cadaver donor. Because this type of bone graft is not obtained from living bone cells, an allograft acts as a scaffold that allows new bone cells to grow through its surface and eventually replace the bone graft over time. Allografts have relatively equivalent fusion rates compared to autografts for single level spinal fusions, but may take longer for the vertebrae to fully fuse together.

Surgical Technique

The surgical technique used to fuse your vertebrae bones together with a lumbar spinal fusion can vary depending on which areas of your spine need to be accessed and fused together. The majority of lumbar spinal fusions were originally performed through making an incision along the back to access the spine, but newer, less invasive techniques are being used to access the spine from the front or sides of the body. Clinical research suggests similar outcomes for all types of lumbar spinal fusion techniques. Your surgeon will decide which surgical technique is most appropriate for you during your lumbar spinal fusion depending on what areas of your spine require treatment.

Posterior Lumbar Interbody Fusion (PLIF)

A posterior fusion is the most common surgical approach for a lumbar spinal fusion where your surgeon will operate from the back (posterior) of your body. You will lay on your stomach on the operating table while an incision will be made down your back through your paraspinal muscles to access your vertebrae. The laminae of the vertebrae will be removed and the facets of the vertebrae will be trimmed down to access the inner portion of the vertebrae. The nerve roots surrounding the affected vertebrae will carefully be moved out of the way while the disc between your vertebrae will be removed from the back of your spine. An implant will be placed between the vertebrae while rods and screws will be placed through the pedicles of the vertebrae to stabilize and hold the vertebrae together. 

Anterior Lumbar Interbody Fusion (ALIF)

An anterior fusion involves operating from the front (anterior) of your body. You will lay on your back on the operating table while an incision will be made through your abdomen, most often to the left of your belly button. The disc between your vertebrae will be removed from the front of your spine and an implant will be placed between the vertebrae. Metal plates may be used to attach the front portions of the vertebrae together for added stability. 

Transforaminal Lumbar Interbody Fusion (TLIF)

A transforaminal (trans = through, foramina = openings in the sides of the vertebrae) fusion involves operating from the back of your body. Like a posterior approach, you will lay on your stomach on the operating table while an incision will be made down your back to access your vertebrae. Rather than the incision being made directly down the middle of your spine, the incision will be made either to the left or to the right of your spine from the back, resulting in less damage to the paraspinal muscles. The facets of the vertebrae will be removed to better access the inner portion of the vertebrae in order to remove the disc between your vertebrae from the back of your spine. An implant will be placed between the vertebrae while rods and screws will be placed through the pedicles only on one side of the vertebrae to stabilize and hold the vertebrae together. 

Lateral Lumbar Interbody Fusion (LLIF)

A lateral (from the side) fusion involves having you lay on your side on the operating table while an incision will be made through your psoas (hip flexor) muscle that lays next to the spine. Most often, an incision will be made on the left side of your body. The disc between your vertebrae will be removed from the side of your spine and an implant will be placed between the vertebrae.

Oblique Lumbar Interbody Fusion (OLIF)

An oblique (at a diagonal angle) fusion involves having you lay on your side on the operating table while an incision will be made through the space between your oblique (abdominal) muscles and psoas (hip flexor) muscle. For an oblique approach, an incision will always be made on the left side of your body. The disc between your vertebrae will be removed from your spine at an oblique angle, or approximately a 45 degree diagonal direction between the front and side of your spine, and an implant will be placed between the vertebrae.

Surgery Recovery Timeline

Full recovery from a lumbar spinal fusion can take between 3-6 months to return to unrestricted activity. If you have a sedentary job, you can generally return to work 4-6 weeks after your surgery. Jobs that require prolonged standing, walking, or bending can require you to take off 12 weeks or more depending on your progress with rehabilitation and how physically demanding your job duties are.