Lumbar Spine Fusion: Lower Back Fusion Surgery & What to Expect

Spine fusion has become increasingly popular in the United States, with elective lumbar (lower) fusion procedures rising over 60% from 2004 to 2015 (1). Despite surgeons' growing use of this procedure, up to 40% of patients do not receive adequate preoperative counseling informing them of their options for surgery and the specific risks and benefits to spine fusion for their case (2). This article discusses some of the common techniques for Lumbar Spine Fusion along with expectations for recovery. Each case is unique, and if you are considering a spine fusion procedure, you should discuss your particular concerns with a licensed healthcare provider.

Surgeons can take a variety of approaches to spine fusion, broadly divided between traditional ("open") approaches and minimally invasive techniques. Lumbar (lower) spine fusion is typically completed with posterior/dorsal approaches (from the back), though anterior/ventral (from the front) techniques exist and have comparable outcomes to posterior surgery though with different complication risks. Given higher risks of mortality and higher costs associated with anterior techniques, posterior approaches are often first-line options, with anterior surgery reserved for situations where specific advantages of anterior techniques would be beneficial (1).

TLIF is an open approach where surgeons access the spine region of interest from the back, though it involves a more lateral approach to the spine itself. It can also be performed with minimally invasive techniques, where it is referred to as MIS-TLIF. TLIF shows the lowest complication rates of all major techniques for lumbar spinal decompression, with lower rates of nerve injury, dural (spinal cavity lining) tears, and need for reoperation (3, 4).

Minimally invasive surgical techniques use high powered cameras and machinery to reduce the need for large incisions and improve recovery time. They are often modeled off of or combined with strategies used for traditional, open approaches to fusion surgery. Most often, minimally invasive techniques are combined with TLIF in a procedure referred to as MIS-TLIF (TLIF using endoscopy or other high powered cameras). If you are curious about specific minimally invasive techniques, you should discuss available options with an expert in spine surgery.