What Is a Spinal Fusion?

Back pain from degenerative spinal conditions can be debilitating and disruptive to your normal activities. In some patients, back pain causes their quality of life to decline, making effective treatment options all the more crucial.

If you’ve been suffering from chronic back pain for several months, surgery may be on the table. Spinal fusion is one form of back surgery that’s commonly used for disorders like spinal stenosis, spondylolisthesis, and herniated disc. It’s widely performed with spinal decompression procedures to restore stability in the spine. 

In some patients, spinal fusion alleviates their back pain and allows them to live a happier, more comfortable life. However, as an invasive surgical procedure, spinal fusion is associated with various risks and complications. In this article, we’ll provide a complete overview of spinal fusion and discuss modern fusion alternatives that back pain patients can now consider. 

Table of Contents

Am I a Candidate For Spinal Fusion?

You may be a candidate for spinal fusion if you have chronic, severe back pain that hasn’t responded to several months of non-surgical treatment. Additionally, candidates for spinal fusion often have limited mobility due to back pain and neurological symptoms.

Candidates for spinal fusion may have one of the following spinal conditions:

  • Spinal fusion
  • Spondylolisthesis
  • Degenerative disc disease
  • Herniated disc
  • Vertebral fracture
  • Scoliosis
  • Spinal tumor

Some patients are not considered candidates for spinal fusion due to a severe, underlying medical condition, or an infection. Additionally, patients with a disease that impacts multiple spinal levels may be advised against spinal fusion surgery due to the higher risk of lost mobility. 

What Are The Steps of Spinal Fusion?

The steps of spinal fusion include accessing the spine through an incision, preparing the bone graft, securing the bone graft between the vertebrae, and closing the incision. These general steps can vary depending on the surgical approach.

Additionally, keep in mind that spinal decompression surgery, such as laminectomy, is often performed immediately before the fusion.  

Surgical Approaches to Spinal Fusion

The primary approaches to spinal fusions that surgeons use today include:

  • PLIF, or posterior lumbar interbody fusion
  • ALIF, or anterior lumbar interbody fusion
  • TLIF, or transforaminal lumbar interbody fusion
  • XLIF, or extreme lateral interbody fusion

The Steps of PLIF

PLIF involves accessing the spine posteriorly, or through the back. During this procedure, the surgeon will complete the following steps:

  1. First, the surgeon creates an incision in the back over the vertebrae to be fused. The back muscles must be moved aside to expose the spine.
  2. If applicable, spinal decompression is performed at this stage. This often involves removing part of the lamina, which covers the back of the vertebra.
  3. Once the decompression has been completed, damaged disc tissue is removed. The bone graft is placed in the disc space between the affected vertebrae. The graft is usually held in place with an implant, such as a spinal cage or interbody spacer.
  4. The back muscles are returned to their normal positions and the incision is closed. 

The Steps of ALIF

ALIF uses an anterior, or frontal, approach with the following steps:

  1. To start, the surgeon creates an incision in the lower portion of the abdomen and moves aside fat and muscle tissue to access the peritoneum. The peritoneum is a sack that contains the abdominal organs. 
  2. Once the surgeon gains access to the peritoneum, they move it to the side to reach the spine without going through the abdomen. Large blood vessels are located over the front of the spine and must also be moved aside to perform the fusion. 
  3. Decompression surgery may be performed at this stage. 
  4. After removing the disc material, the surgeon positions the bone graft in the disc space with the help of an implant. 

The Steps of TLIF

Transforaminal lumbar interbody fusion is completed through the foramina, which are the bony openings located between adjacent vertebrae. This approach to spinal fusion may be suggested if the patient has spinal degeneration that’s mainly on one side of the spine. 

  1. For TLIF, the surgeon creates an incision along the spine, directly above the affected vertebra. Similar to PLIF, the surgeon must move the back muscles aside to reach the spine. 
  2. The surgeon can now access the disc space by drilling from one side of the spine, then extracting the lamina and/or facet joint. 
  3. At this point, the damaged intervertebral disc material is removed and the bone graft is positioned in its place, secured by a fusion implant. 
  4. The back muscles are repositioned and the incision is closed with sutures. 

The Steps of XLIF

XLIF is a minimally-invasive approach to spinal fusion. This is a relatively new surgical method that eliminates the need to create an incision in the abdomen or cut the large muscles of the back. 

  1. First, the surgeon makes an incision in the flank, which is the lower back area of the abdomen. The peritoneum must then be moved away from the abdominal wall. 
  2. Next, a dilator is placed into the peritoneum and moved toward the affected disc. The surgeon takes fluoroscopy images to confirm that the dilator is in the optimal position. 
  3. To prevent nerve interference, a probe is placed through the psoas. 
  4. At this stage, the surgeon removes the damaged disc and puts bone graft material in its place, through the incision in the flank. 
  5. The peritoneum is returned to its usual position and the incision is closed with sutures.

How Long Does Spinal Fusion Take?

Spinal fusion surgery takes between four and seven hours, in most cases. The more complex the procedure, the longer the surgery will take to complete. 

After fusion surgery, you can expect to stay in the hospital for two to seven days. If you undergo a minimally-invasive form of the procedure, you’ll likely be released from the hospital sooner. During your hospital stay, you may be given prescription pain medication through an IV to manage discomfort from the procedure. Additionally, if you have pain around the incision, you may be given a soft brace. 

While you’re in the hospital, you’ll probably start to work with a physical therapist to complete basic activities, including sitting up in bed, standing up, walking without bending the spine, and getting dressed. Your therapist can also advise you on how to safely care for your incision. 

What is The Average Recovery Time for a Spinal Fusion?

The average recovery time for a spinal fusion is six months to a year. This is the amount of time required for the spine to heal completely. 

Spinal Fusion Recovery

Spinal fusion recovery is a relatively long process involving several stages. Your surgeon will help guide you through these stages, advising you on the activities that you can resume – and those that you should continue to avoid. 

Here’s a general timeline of the spinal fusion recovery process:

1 to 4 Weeks

During this phase of your recovery, your activities will be relatively limited. You may still need help to complete light housework, and you’ll likely still need medication for pain management.

However, if you have a sedentary job, you may be able to return to work within a few weeks of the procedure. You’ll need to avoid bending or twisting the spine, lifting anything other than light objects, and driving. 

1 to 3 Months

One to three months after spinal fusion, you’ll start to complete basic chores around the house. Your doctor may also clear you to drive during this stage. However, you still won’t be able to bend, twist, or lift heavy objects. 

During this phase, you’ll be attending physical therapy to ensure that the spine heals properly. A physical therapist will help you regain strength and mobility without jeopardizing the fusion process. 

3 to 6 Months

During this stage of spinal fusion recovery, you can gradually return to cardiovascular exercise and stretching. While you won’t be able to bend the spine or lift heavy objects, your activities won’t be as restricted.  

6 Months to 1 Year

During this period, your surgeon can determine if the fusion was successful. If the vertebrae fused properly and the spine appears healthy, you can return to most of your usual activities, including bending and twisting the spine. Keep in mind that some mobility is lost to the fusion process, so your spinal mobility will still be somewhat limited. 

Beyond the 1-year mark, your vertebrae may continue to heal, along with any damaged nerves. In some cases, spinal nerve damage takes two years to heal completely. However, most patients are virtually pain-free after a year of recovering from spinal fusion. 

What Are The Risks and Complications of Spinal Fusion?

The risks and complications of spinal fusion include limited mobility, pseudoarthrosis, adjacent segment disease, recurrent pain, and muscle atrophy. These risks are in addition to those of all surgical procedures, such as infection, blood clots, and adverse reactions to anesthesia. 

Limited Mobility

Limited mobility can occur after spinal fusion due to lost mobility at the fused segment. Once the vertebrae have fused into a single bone, the patient loses the ability to bend or twist at that segment. In some cases, patients require a reacher tool to retrieve items on the floor after spinal fusion. 

Lost mobility is particularly common after multi-level fusions. However, even for patients undergoing a single-level fusion, it’s crucial to talk to your surgeon about how lost spinal mobility could impact your lifestyle. 


Pseudoarthrosis, or failed fusion, occurs when the vertebrae fail to fuse after the surgery. Unfortunately, pseudoarthrosis continues to be a risk with modern fusion methods. This complication typically creates the need for additional surgery. 

According to a clinical review published in 2022, rates of pseudoarthrosis range greatly from 0% to 20% to greater than 60%, depending on which study you reference. A 2015 study noted that at least 15% of patients who undergo primary lumbar fusion experience pseudoarthrosis. 

While the exact rate of pseudoarthrosis is unclear, it’s a distinct risk, particularly for patients who smoke, use steroids or have diabetes.  

Adjacent Segment Disease

Adjacent segment disease, or ASD, is a possible complication of spinal fusion. It develops when the spinal segments above and below the fused segment degenerate more rapidly than usual. This occurs because the adjacent segments must compensate for the lost motion at the fused segment.  

As the adjacent segments start to degenerate, patients may experience back pain and/or neurological symptoms, such as tingling, weakness, and numbness. Eventually, some patients with ASD require reoperation to resolve their symptoms. 

ASD is estimated to impact 11 to 12% of patients 5 years postoperatively and 16 to 38% at the 10-year mark. 

Recurrent Pain

In some cases, spinal fusion surgery doesn’t resolve the patient’s back pain. This may occur in up to 40% of patients. 

Muscle Atrophy

Muscle atrophy is the term used for muscle tissue that thins out or wastes away. Since spinal fusion limits how much patients can use their back muscles, it can lead to muscle atrophy. When the muscle tissue around the spine atrophies, it reduces support for the spine and increases the risk of future injury. 

Surgical Risks

All surgical procedures come with certain risks, including:

  • Hemorrhage
  • Shock
  • Deep vein thrombosis
  • Pulmonary embolism
  • Infection
  • Allergic reactions to anesthesia

Alternative to Lumbar Spinal Fusion

Given the risks and complications of spinal fusion, many patients look for alternative treatment options. Thankfully, the latest advancements in medical technology have paved the way for fusion alternatives, including the TOPS System.

Take back control of your life with Premia Spine!

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Bonnie explains why TOPS surgery was the right decision for her

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Scott speaks about going to surgery

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The TOPS System is a non-fusion implant that stabilizes the spine without permanently fusing the vertebrae or compromising the patient’s range of motion. It moves with the spine, preventing lost mobility, adjacent segment disease, and related complications. 

Talk to a spine specialist in your area to learn more about alternatives to fusion for chronic spinal conditions.