Overview
A lumbar fusion joins two or more vertebrae in the lower back so they heal into one solid bone. It is used to stop painful or harmful motion, correct alignment, or stabilize the spine after a decompression.
The approaches are named for the direction the surgeon reaches the disc space: from the back, the side or the front.
Watch and learn
Video: “What Is Transforaminal Lumbar Interbody Fusion (TLIF)? | Ask Cleveland Clinic's Expert” from Cleveland Clinic on YouTube. It loads from youtube-nocookie.com only when you press play. Shown for general education; GSMC did not produce it. Watch on YouTube
Video: “What Happens During an ALIF Procedure? | Ask Cleveland Clinic’s Expert” from Cleveland Clinic on YouTube. It loads from youtube-nocookie.com only when you press play. Shown for general education; GSMC did not produce it. Watch on YouTube
Captions: press the CC button in the video player to turn on captions. Some captions are generated automatically by YouTube and may contain errors.
Who may be a candidate
- Spondylolisthesis or instability with ongoing symptoms
- Stenosis that needs decompression where stability is a concern
- Deformity or certain fractures
- Selected cases of disc-related pain after extensive nonsurgical care
Your exam, imaging and overall health decide whether this surgery is appropriate for you.
How it is done
- TLIF (transforaminal): from the back, through one side of the spine; the disc is removed and a spacer is placed, then screws and rods are added.
- PLIF (posterior): from the back, reaching the disc from both sides.
- ALIF (anterior): from the front through the abdomen, which allows a large spacer; screws may be added from the back.
- XLIF/LLIF (lateral): from the side of the body through a small incision, passing through the psoas muscle.
- In all approaches, bone graft is placed so the vertebrae grow together over months. Some fusions are done with minimally invasive techniques.
This surgery is usually performed in a hospital, sometimes with an overnight or longer stay. Procedures that are appropriate for outpatient care may be performed at GSMC’s surgery center; others are done in a hospital. Your surgeon will explain what to expect.
Recovery timeline
Usually 1–4 days; walking starts the day of or after surgery.
Avoid bending, lifting and twisting; walking daily.
Therapy and gradual return to activities.
Fusion continues to solidify.
Recovery depends on the procedure, your health and how many levels are treated. Your surgeon will give you a written plan.
Risks
Every surgery has risks. Your surgeon will review them with you, including:
- Infection or bleeding
- Nerve injury
- Blood clots
- Nonunion (fusion does not heal)
- Hardware problems
- Adjacent segment degeneration
Alternatives to consider
- Laminectomy / Decompression
- MILD Procedure
- Intracept (Basivertebral Nerve Ablation)
- Spinal Cord Stimulation
- Core strengthening
See all nonsurgical options, or ask for a second opinion.
Who performs it
Call 732-202-3000 to confirm which surgeon performs this procedure and where.
Frequently asked questions
Which approach is right for me?
It depends on your anatomy, the level, the problem being treated and your surgeon’s assessment.
Does smoking affect fusion?
Yes. Smoking and nicotine raise the risk of the fusion not healing. Quitting before surgery is strongly advised.
Will I have hardware for life?
Screws and rods usually stay in place unless they cause a problem.
This page is general patient education and does not replace advice from your own clinician. Individual results vary. No outcome can be promised.