Not everybody with low back pain will require surgery. But if your condition is one that requires surgery, rest assured that spinal fusion has a long history as a treatment option.

A spinal fusion is the permanent joining of two or more vertebrae so that there is no movement between them. Over time they heal into a single, solid bone. The procedure involves roughening the bone between two adjacent vertebrae and then placing bone graft between them. In some cases, disc material may be replaced with donated bone, or in the case of degenerative disc disease with or without Grade 1 spondylolisthesis, plastic or metal spacers may be used instead. Rods and screws are then placed to create an "internal cast" that support the vertebrae, holding it together until the fusion, or bony regrowth, can occur.

Spine surgery involves creating a single incision and stripping the muscles from the spine. In comparison to a minimally invasive technique, the “open” method offers key benefits that include:

  • Increased access to the spine to remove the damaged bone or intervertebral discs with less likelihood of leaving compressive elements behind
  • Greater visibility to the surgeon in order to place the rods, screws, and bone graft materials needed to stabilize the spinal bones, and hence create less risk of damage to nerves or surrounding structures

When surgeons replace disc material with either bone, plastic, or metal spacers, they may approach the disc space in different ways:

  • Anterior lumbar interbody fusion (ALIF) – An incision is made in the abdomen
  • Posterior lumbar interbody fusion (PLIF) – An incision is made in the back
  • Transforaminal lumbar interbody fusion (TLIF) – An incision is made in the back next to the spine to access the vertebra at an angle
  • Direct lateral interbody fusion (DLIF) – An incision is made on the side of the abdomen

All these procedures can also be done using a minimally invasive technique, and all involve joining different parts of two or more vertebrae together. Your surgeon will decide on the best approach after considering various factors, including the spinal condition to be treated, its location in the spinal column, and your overall health.

  • Approaching the Spine From the Front

    An anterior lumbar interbody fusion (ALIF) involves approaching the spine through an incision in the abdomen.

    What to expect

    Surgery is performed with the patient lying on his or her back. The surgeon makes an incision in the patient's abdomen to access the spine. The surgeon then retracts the abdominal and vascular structures. Once the spine is in view, disc material can be removed and bone graft material and spinal implants can be inserted.

    After surgery

    The length of hospital stay will depend on the patient and the surgeon's postoperative treatment plan.

  • Approaching the Spine From the Back

    Both the posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) involve approaching the spine through an incision in the back.

    What to expect

    Surgery is performed with the patient lying on his or her stomach. The surgeon will make an incision in the patient’s back to access the spine. The surgeon then retracts muscles and nerve roots. Once the spine is in view, disc material can be removed and bone graft material and spinal implants can be inserted.

    After surgery

    The length of hospital stay will depend on the patient and the surgeon's postoperative treatment plan.

  • Approaching the Spine From the Side

    A direct lateral interbody fusion (DLIF) involves creating a small passageway through the soft tissue and the psoas muscle of the side (rather than through the abdomen or back)—directly to the spine.

    What to expect

    For this procedure, the patient is positioned on their side. An incision is made into the patient's side. Using real-time, flouroscopic x-ray guidance, tubular dilators are inserted creating a "tunnel" and disc material can be removed. Bone graft material and spinal implants can then be inserted.

    After surgery

    The length of hospital stay will depend on the patient and the surgeon's postoperative treatment plan.

What Are the Risks of Spinal Fusion?

Potential risks to any surgical procedure include unforeseeable complications caused by anesthesia, blood clots, undiagnosed medical problems such as silent heart disease, and rare allergic reactions. Complications of spinal surgery can include neurological damage, damage to the surrounding soft tissue and, where used, instrument malfunction. Most of these complications can be treated once they are detected, but sometimes they require a longer period of hospitalization or recovery, additional medications, and sometimes even additional surgery. Depending upon the type of surgery you are having, these risks will be explained by the primary surgeon. Other risks associated with implants used include device migration, loss of spinal curvature, correction, height, and/or reduction. As a patient, it is important to understand and follow your doctor’s advice so that the best possible outcome can be achieved. Surgery is not for everyone. Please consult your physician.