Types of Spinal Fusion Surgery

Spinal fusion is widely used to treat chronic, debilitating back pain and spinal instability. At its most basic, the procedure involves fusing two (or more) vertebrae using bone graft material. However, many types of spinal fusion surgery exist, with differing approaches to accessing and treating the spine. 

Here, we’ll analyze the various types of spinal fusion surgery, how they differ, and spinal fusion alternatives to consider for a lower risk of long-term complications. 

Types of Spinal Fusion Surgery

The different types of spinal fusion surgery include transforaminal lumbar interbody fusion, lateral lumbar interbody fusion, posterior lumbar interbody fusion, anterior lumbar interbody fusion, and anterior cervical fusion. 

Transforaminal Lumbar Interbody Fusion (TLIF)

Transforaminal lumbar interbody fusion involves accessing the spine through the foramina, the bony passages through which nerve roots depart the spine and travel throughout the body. Interbody fusion means the surgeon extracts the intervertebral disc between the affected vertebrae before fusing them together. Lumbar fusion means the procedure is done on the lower part of the spine (vertebrae L1 through L5). 

Spinal surgeons may recommend TLIF over other types of spinal fusion when a patient has one-sided disc degeneration, as it involves accessing the disc space slightly from the side. Additionally, compared to PLIF, TLIF involves less blood loss and a lower risk of nerve injury. 

Lateral Lumbar Interbody Fusion (LLIF)

Lateral lumbar interbody fusion involves accessing the spine from the side, through an incision in the flank. This makes it possible to approach the vertebrae without cutting through the back muscles, often leading to less bleeding and post-operative pain.

There are a few different procedures that fall under the umbrella of LLIF: extreme lateral and anterolateral interbody fusion. 

  • Extreme or direct lateral interbody fusion, often called XLIF or DLIF, involves accessing the spine through the psoas muscle. The psoas muscles are located deep within your core and extend down both sides of the spine to the pelvis. 
  • Anterolateral interbody fusion, often called OLIF or ATP, involves reaching the spine by going in front of the psoas. This approach avoids disrupting the psoas muscle.

Posterior Lumbar Interbody Fusion (PLIF)

Posterior lumbar interbody fusion involves accessing the spine posteriorly, through the back. The surgeon removes the lamina (a flat piece of bone at the back of the spinal canal) to extract the intervertebral disc and position the bone graft material. The process of removing the lamina is called a laminectomy, and it’s commonly performed in conjunction with spinal fusion.

Since PLIF requires cutting through the back muscles, it typically involves more blood loss, longer operating times, and a higher risk of nerve damage than TLIF and other minimally invasive forms of spine surgery. 

Anterior Lumbar Interbody Fusion (ALIF)

Anterior lumbar interbody fusion involves accessing the spine anteriorly, through the front of the body. The surgeon makes an incision in the abdomen, navigates through the abdominal muscles, and moves the peritoneum (the tissue that encases most of the abdominal organs) to one side. This allows them to access the spine, remove the damaged spinal disc, and position the bone graft material.  

Anterior Cervical Discectomy and Fusion (ACDF)

Anterior cervical discectomy and fusion involves accessing the cervical spine through the front of the throat to alleviate nerve impingement. The surgeon then removes the damaged spinal disc and positions bone graft material for fusion. This type of spinal fusion is used to treat various neck issues, including herniated discs, bone spurs, and other osteoarthritis complications. 

Post-Surgery Expectations

Your post-surgery expectations for spinal fusion should include a three to four-day hospital stay, several months of strict mobility restrictions, and regular physical therapy sessions. Other considerations include:

  • Time off work: Depending on how physically demanding your job is, you may need to take one to six months off. 
  • Household tasks: After spinal surgery, you won’t be able to perform certain day-to-day tasks, at least for the first few weeks. This makes it crucial to prepare your home by placing essential items on low shelves, meal prepping, and doing laundry. It’s also best to have a loved one stay with you after surgery to help with basic tasks. 
  • Pain levels: Some back pain and stiffness are to be expected after spinal fusion surgery. Your surgeon will prescribe pain medications to help manage your discomfort, particularly in the early stages of recovery. Most people take painkillers for a few weeks to a month after the procedure. 
  • Permanent restrictions: Permanent restrictions after spinal fusion include significant spinal bending, twisting, and flexing. You may also need to permanently avoid certain high-impact activities, like running and contact sports, that could injure the spine. 

Spinal Fusion Surgery FAQs

Spinal fusion surgery FAQs include:

What supplements should you avoid after spinal fusion?

Supplements you should avoid after spinal fusion include vitamin E and fish oil. Both may thin your blood and interfere with bone formation, which can affect your risk of failed fusion. 

While they’re not technically supplements, you should also avoid NSAIDs, like aspirin and ibuprofen, after spinal fusion. NSAIDs compromise prostaglandin production, which may compromise bone growth at the fusion site. 

What promotes bone growth after spinal fusion?

Following your doctor’s pre- and post-operative instructions, eating a nutrient-rich diet, staying mobile, and quitting smoking can promote bone growth after spinal fusion. 

  • Closely following your doctor’s instructions before and after the procedure will help prevent overextending the spine, which could compromise bone healing. These instructions will include activity restrictions, dietary guidelines, and other lifestyle recommendations.    
  • A diet rich in nutrients, particularly calcium and vitamin D, can help your bones effectively heal after spinal fusion. Protein, vitamin K, vitamin C, and zinc are other important nutrients to support post-operative healing.   
  • Staying mobile with gentle physical activity (that fits within your surgeon’s guidelines) can promote bone growth by improving blood circulation to the fusion site. 
  • Quitting smoking before spinal fusion can help lower your risk of certain complications and encourage bone growth. As a vasoconstrictor, nicotine curbs blood flow throughout the body, starving the bone graft of the oxygen and nutrients it needs to fuse successfully. 

When is spinal fusion necessary?

Spinal fusion is necessary for people experiencing severe back pain, disability, and/or spinal instability from conditions like spinal stenosis, nerve impingement, spondylolisthesis, and scoliosis. Your surgeon may deem it necessary after conservative treatments fail to resolve your symptoms, and if you’re not a candidate for less invasive alternatives. 

What are the most common problems after spinal fusion?

The most common problems after spinal fusion include recurrent back pain, graft site pain, neurological symptoms, hardware damage, fusion failure, lost mobility, and adjacent segment degeneration. 

Lumbar Fusion Alternatives

Lumbar fusion alternatives include conservative methods, regenerative medicine, and non-fusion implants like the TOPS System. 

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Scott speaks about going to surgery

Conservative treatment methods like physical therapy, pain medications, lifestyle modifications, chiropractic care, massage therapy, and acupuncture can help treat lumbar spine problems without fusion. In many cases (especially those that are addressed early), these treatments help patients reach symptom relief without going under the knife. This can allow you to sidestep surgical risks and recovery times, but may not be sufficient for more severe cases. 

Regenerative medicine harnesses materials that support the body’s natural recovery processes, like stem cells, to promote tissue growth. Regenerative treatments are usually minimally invasive and can help repair damaged tissues in the lumbar spine. However, these therapies are still emerging, and more research is required to confirm their effects on various lumbar spine conditions. 

The TOPS System is an exciting lumbar fusion alternative for degenerative spondylolisthesis and lumbar spinal stenosis. It even earned a superior-to-fusion claim to the FDA for its ability to stabilize the spine after lumbar decompression surgery without compromising the spine’s natural range of movement. This means that you can achieve lasting symptom relief while maintaining spinal mobility and avoiding a lengthy recovery process. 

Interested in the TOPS System as a way to avoid spinal fusion for spondylolisthesis and lumbar spinal stenosis? Find a doctor near you to learn more.