Lumbar Interbody Fusion: ALIF PLIF TLIF DLIF

Anterior, Posterior, Transforaminal, Direct Lateral Fusion Surgery

Lumbar Interbody Fusion (LIF) surgery is a surgical procedure performed to treat low back problems such as degenerative disc disease, herniated disc, and spondylolisthesis. The purpose of LIF is to reduce back and/or leg pain and stabilize the spine. Often, ALIF, PLIF, TLIF, and DLIF can be performed using minimally invasive techniques. Be assured that your neurosurgeon recommends the best approach based on your medical history, spine problem, previous treatments, and other factors.

After all or part of the damaged disc is removed (discectomy), the interbody space is prepared, and one or two interbody devices are implanted between the upper and lower vertebral bodies.

Depending on the type of interbody device (such as a cage), bone graft is packed inside and around the device.  Bone graft stimulates the vertebral bone to heal and fuse solid.

Types of lumbar interbody fusion (LIF)

Anterior Lumbar Interbody Fusion (ALIF)

Your neurosurgeon accesses your spine from the front of your body (anterior) by making an incision in your abdomen.

Posterior Lumbar Interbody Fusion (PLIF)

PLIF approaches your spine from your backside (posterior). The procedure involves a laminotomy or laminectomy (complete removal of the lamina), and trimming away or removal of a facet joint. This gives your neurosurgeon access to the spinal canal, disc, and nerve roots.

Transforaminal Lumbar Interbody Fusion (TLIF)

A TLIF is an extension of a PLIF procedure. During TLIF, the surgeon has access to the front and back of your spine. The damaged disc is removed from the front or side of your body, and the interbody devices and bone graft implanted. Then, the back of your spine (posterior) is instrumented using rods, pedicle screws, and more bone graft to stabilize the spine.

Direct Lateral Interbody Fusion (DLIF)

The DLIF procedure involves a small skin incision in your side (therefore, direct lateral). Using minimally invasive surgical techniques, the neurosurgeon separates muscles (psoas muscle) and soft tissues to access the intervertebral disc. Because access to the spine is through the psoas muscle, DLIF is sometimes called a trans-psoas LIF or approach.

Before your lumbar interbody fusion surgery

Well in advance of your surgery day, your neurosurgeon explains how he performs your procedure.  During the discussion, you learn if your procedure can be performed as a minimally invasive spine surgery or open approach, and why.

Before surgery, you visit your primary care doctor or general practitioner to obtain a general health clearance. This means your doctor has carefully evaluated your health in terms of undergoing surgery.  Your assessment may include blood tests, x-rays or other imaging studies, as well as special tests for existing medical problems (i.e., diabetes, heart disease).

Potential benefits and risks of ALIF, PLIF, TLIF, DLIF

Of course, the potential benefits of the surgery are important to know, but so are the possible risks and complications. Your risks and complications may be different from those of another patient because you are unique. Your neurosurgeon takes that into serious consideration and thoughtfully explains potential risks to you, which may include infection, bleeding, reaction to anesthesia, and nerve damage.

ALIF, PLIF, TLIF and DLIF Surgeries

ALIF, PLIF, TLIF and DLIF procedures are performed under general anesthesia. Throughout your procedure, the neurosurgeon and his surgical team are consistently kept current on your vital functions, including your central nervous system. Many different gauges, monitors, and equipment provide visual and audio feedback to the surgical team. Image guidance (real time x-ray; fluoroscopy) allows your neurosurgeon to see other views of the surgical field during (intra-operative) your procedure.

After ALIF, PLIF, TLIF or DLIF surgery

You are moved from the operating room into the recovery area. Here, the nurses and medical staff closely monitor your vital signs with attention to managing post-operative pain. You should expect some discomfort. You may have pain at the incision site, occasional neck or back muscle spasms, or other symptoms. When you wake up, you may be wearing a lumbar brace.

Post-operative care for lumbar interbody fusion

Your surgery is over, but now your recovery starts! If you do not understand your post-surgical instructions or a problem develops, please call us-we are here to help you.

Conventional post-spine surgery instructions

• Schedule your post-operative appointment call (281) 446-3876
• Wear your brace as instructed
• Keep your incision dry and clean
• You may shower, but keep your incision covered and dry
• Rest; you will fatigue easily while your body heals
• Do not take a tub bath, go swimming, or sit in a hot tub or pool
• Begin physical therapy and/or exercise as instructed
• Take medications as prescribed
• Do not lift or carry anything heavier than a shoe
• Walking is encouraged
• Do not drive until cleared by your neurosurgeon
• Avoid riding in a car; short distances are permitted
• Do not smoke or use tobacco
• Eat well, your body needs nutritious food to heal

Call your neurosurgeon’s office (281) 446-3876

• Fever 101 degrees Fahrenheit or higher
• Redness and/or swelling around the incision site expands
• Change in the amount, odor or appearance of the incision drainage
• Incision pain increases
• Bowel or bladder dysfunction develops
• Genital area numbness develops

Talk with your neurosurgeon

We hope this information about lumbar interbody fusion has answered your immediate questions.  Remember, your neurosurgeon is your most valuable source to answer your questions about symptoms, treatment and your healthcare.

Learn more about interbody fusion surgery from these online sources:

• Interbody Fusion – ALIF, PLIF and XLIF via Spine Health
• An academic paper comparing low back interbody fusion surgeries
• DLIF Video from Medtronic on Back.com