Back pain can cause discomfort and also disrupt your everyday routine. When conservative treatments like physiotherapy or medication no longer help, doctors may recommend spinal fusion. This surgical procedure involves joining two or more vertebrae to eliminate painful motion and stabilise the spine.
With various approaches available, the procedure is carefully chosen based on a personal conditions. Spinal fusion is typically considered when chronic back pain stems from conditions like disc degeneration, spinal stenosis, or deformities such as scoliosis, says Dr Ashish Tomar, Senior Consultant, Orthopaedics and Spine Surgery, Sarvodaya Hospital, Faridabad. “It’s also used in cases of vertebral fractures, tumors, or infections. The main goal of spinal fusion is to provide long-term relief by removing motion at a painful vertebral segment,” he explains.
Additionally, when medications, rest, or physical therapy fail to offer sustained improvement, fusion may be the next step. “This is especially true if symptoms like numbness, tingling, or muscle weakness start to affect daily life or signal possible nerve damage. Spinal fusion is a serious procedure—but for many, it's also life-changing," Dr Tomar says.
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Deciding the surgical route:
Not all spinal fusions are the same. The surgical approach depends on the patient’s anatomy, the location of the issue, and the surgeon’s goal, whether it’s stability, nerve relief, or structural correction. “Each technique has its own advantages, and choosing the right one helps in faster recovery and better outcomes. For example, anterior approaches like ALIF allow direct access to the disc space without disturbing the spinal muscles, often reducing post-operative pain," he says.
Posterior methods like PLIF and TLIF offer better access to spinal nerves but involve more muscle disruption. “Lateral and oblique approaches, which are newer and minimally invasive, are gaining popularity for being less traumatic and promoting faster recovery. The right technique is often determined after thorough imaging and patient evaluation. Recovery varies depending on the approach, but successful spinal fusion can help improve quality of life,” Dr Tomar says.
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He lists the types of spinal fusion based on surgical approach:
- Anterior lumbar interbody fusion (ALIF): The spine is accessed through the abdomen. This allows the surgeon to remove the damaged disc and insert a bone graft with minimal disruption to back muscles.
- Posterior lumbar interbody fusion (PLIF): The spine is accessed directly from the back. This gives clear access for inserting the graft but may involve more muscle dissection.
- Transforaminal lumbar interbody fusion (TLIF): A variation of PLIF, this technique approaches the spine from a more sideward angle to reduce pressure on nerves during surgery.
- Lateral lumbar interbody fusion (Llif or XLIF): In this approach, the spine is accessed from the side with the patient lying on their side. It’s less invasive and ideal for certain spine levels.
- Oblique lumbar interbody fusion (OLIF): Similar to LLIF, but the surgeon enters from a slightly different angle, avoiding major blood vessels and muscles for a quicker recovery.
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