Lumbar Interbody Fusion Surgery
Lumbar Interbody Fusion is a surgical procedure performed to treat a variety of spinal conditions, primarily degenerative disc disease, instability, spondylolisthesis, recurrent disc herniation, and spinal deformities. The technique involves removing the damaged intervertebral disc (complete discectomy) and inserting an interbody cage filled with bone graft material between two vertebral bodies. This helps promote bony fusion between the vertebrae, stabilizing the spine and relieving pain caused by abnormal movement or nerve compression.
Why Interbody Fusion?
The interbody space offers the most biologically favorable environment for fusion because:
- It provides a large surface area for bone-to-bone contact.
- It allows insertion of a substantial amount of bone graft, which promotes solid fusion.
- The graft is placed under compressive forces, which further enhances the likelihood of successful fusion.
Types of Lumbar Interbody Fusion Techniques
Depending on the anatomical route and clinical goals, there are several surgical approaches for lumbar interbody fusion:
- Posterior Lumbar Interbody Fusion (PLIF)
PLIF is the traditional method where the spine is approached from the back (posterior). The interbody space is accessed through the spinal canal, navigating between the spinal cord and facet joints. After removing the intervertebral disc, a cage with bone graft is inserted. Though effective, PLIF may require significant retraction of neural structures, which can increase the risk of nerve irritation.
- Transforaminal Lumbar Interbody Fusion (TLIF)
TLIF also uses a posterior approach but accesses the disc space from a more lateral angle, thereby avoiding direct manipulation of the spinal cord. A portion of the facet joint is removed to reach the disc through the foramen (nerve root exit zone). TLIF reduces the risk of nerve injury and is particularly useful in revision surgeries, where scar tissue from previous operations may complicate a central posterior approach.
TLIF is also the foundation for Minimally Invasive TLIF (MIS TLIF), discussed below.
- Anterior Lumbar Interbody Fusion (ALIF)
In ALIF, the surgeon approaches the spine from the front (anterior), typically through the abdomen in collaboration with a general or vascular surgeon. This method offers direct access to the disc space without disturbing spinal nerves. A large cage can be inserted, providing better structural support and accommodating more graft material. ALIF is often chosen for L5-S1 fusions and in patients needing lordosis correction.
- Lateral/Extreme Lateral Lumbar Interbody Fusion (LLIF/XLIF)
LLIF/XLIF approaches the lumbar spine from the side (lateral). Through a minimally invasive muscle-splitting approach, a long, wide cage is inserted transversely across the disc space. This technique offers:
- Excellent mechanical support,
- A large graft footprint,
- The ability to correct spinal deformities, such as adult degenerative scoliosis.
Because the spinal canal is not entered, there is minimal risk to the neural elements, but care must be taken to protect the lumbar plexus, which runs through the psoas muscle.
- Oblique Lumbar Interbody Fusion (OLIF)
OLIF is a refinement of the lateral approach, where the disc space is accessed from a slightly anterior and oblique direction. This allows the surgeon to avoid the psoas muscle altogether, thus reducing postoperative thigh pain or hip flexor weakness, which can occur with LLIF. OLIF preserves the benefits of a large cage and wide graft area while offering a safer anatomical corridor.
Alternative Fusion Approach: Posterolateral Fusion (PLF)
In some cases, spinal fusion can be achieved without an interbody cage. Posterolateral Lumbar Fusion (PLF) involves placing bone graft over the transverse processes and facet joints on the outer sides of the vertebrae. Though less invasive in terms of disc work, PLF offers limited surface area for fusion and does not restore disc height. It is generally considered when interbody techniques are not feasible.
Highlight: Minimally Invasive TLIF (MIS TLIF)
MIS TLIF has become one of the most commonly performed lumbar fusion surgeries. It combines the benefits of the TLIF approach with the principles of minimally invasive surgery:
- Small incisions and minimal muscle disruption,
- Tubular or expandable retractors to create a working corridor,
- Microscopic or endoscopic visualization for precision,
- Cage and bone graft insertion through these retractors,
- Pedicle screws and rods placed via:
- The same retractor,
- Percutaneously under fluoroscopy,
- Computer-assisted navigation or robotic guidance.
MIS TLIF results in:
- Reduced blood loss,
- Faster recovery,
- Lower risk of infection,
- Shorter hospital stays,
- Quicker return to daily activities.
Choosing the Right Approach
Every fusion technique shares a common goal—to achieve a stable, solid union between two vertebrae. However, the choice of approach depends on:
- The level of the spine involved,
- The underlying pathology (degeneration, instability, deformity),
- Prior surgeries or scar tissue,
- Surgeon’s expertise and experience,
- Patient-specific factors like age, bone quality, and comorbidities.
We offer a personalized treatment plan tailored to each patient’s condition, aiming to restore spinal stability and quality of life with the most advanced and minimally invasive techniques available.
Frequently Asked Questions (FAQs) Lumbar Fusion Surgery
Lumbar fusion surgery is a procedure where two or more vertebrae in the lower back (lumbar spine) are permanently joined to eliminate movement between them. It is recommended for patients with chronic lower back pain due to degenerative disc disease, spinal instability, spondylolisthesis, or recurrent herniated discs. The goal of the surgery is to provide stability, relieve pain, and improve mobility.
In a lumbar fusion procedure, a cage (an implant made of titanium or PEEK) is placed between the vertebrae to maintain disc height and encourage bone growth. The cage provides structural support while allowing bone to grow through and around it, leading to natural fusion over time. This technique ensures proper alignment, reduces pain, and enhances long-term spinal stability.
The cost of lumbar fusion surgery in Mumbai varies depending on several factors, including the hospital, surgeon’s expertise, type of implant used, and whether it is a minimally invasive or open surgery. On average, the cost ranges from ₹3,00,000 to ₹7,00,000. This includes pre-surgical evaluations, surgical fees, hospital stay, and post-operative care. Patients are advised to check with their insurance provider for coverage details.
Lumbar fusion and decompression are two different spinal procedures. Decompression surgery (such as laminectomy or discectomy) removes pressure from the spinal nerves by eliminating bone or disc material. In contrast, lumbar fusion surgery stabilizes the spine by fusing two or more vertebrae, usually when instability is a concern. In some cases, both procedures are performed together to relieve nerve compression while ensuring spinal stability.
Lumbar fusion at the L4-L5 level is one of the most common spinal fusion procedures. This segment of the spine is responsible for significant motion and bears a substantial load. Patients suffering from severe disc degeneration, spinal stenosis, or spondylolisthesis at this level may experience chronic pain, instability, or nerve compression. Fusion of L4-L5 helps restore stability and alleviate symptoms, improving overall spinal function.
Recovery from lumbar fusion surgery typically takes 3 to 6 months, but complete bone fusion may take up to a year. In the first few weeks, patients are advised to avoid bending, lifting, or twisting. Physical therapy usually starts within 6 to 12 weeks to regain strength and mobility. The recovery timeline varies based on the patient’s age, overall health, and adherence to post-operative care instructions.
Like any surgical procedure, lumbar fusion carries some risks, including infection, blood clots, nerve damage, and non-union (failure of bones to fuse). Some patients may also experience adjacent segment disease, where the nearby spinal segments undergo stress due to reduced mobility at the fused level. Choosing an experienced spine surgeon in Mumbai and following post-surgical guidelines can minimize these risks.
Yes, minimally invasive lumbar interbody fusion (MIS TLIF or XLIF) is a modern surgical approach that involves smaller incisions, less muscle damage, reduced blood loss, and faster recovery compared to traditional open surgery. This technique is highly effective in stabilizing the spine while minimizing post-operative pain and hospital stay duration. However, candidacy for minimally invasive surgery depends on the severity of the condition.
After lumbar fusion surgery, patients are encouraged to maintain a healthy lifestyle to support spinal health. This includes:
- Engaging in low-impact exercises like walking and swimming.
- Avoiding heavy lifting and high-impact activities for several months.
- Maintaining a healthy weight to reduce stress on the spine.
- Practicing proper posture and ergonomics in daily activities.
Regular follow-ups with the spine surgeon are essential to monitor healing and prevent complications.
Lumbar fusion surgery reduces movement at the fused segment, but patients can still perform daily activities with minimal restrictions. Most people regain good mobility, especially with physical therapy. However, extreme bending and twisting at the fused levels may be limited, and patients may need to adapt certain movements to protect their spine.
