Spine Surgery: Lumbar Interbody Fusion

PLIF, TLIF, ALIF and LLIF spine surgeries to alleviate back pain

By HSS Spine

A variety of techniques exist for fusing lumbar spine vertebrae to help alleviate back pain, including posterior, transforaminal, anterior, and lateral lumbar interbody fusion (PLIF, TLIF, ALIF, and LLIF, respectively).

Spine surgeons in the operating room doing surgery.

The animations below provide inside views to each of these surgical procedures.

Posterior lumbar interbody fusion (PLIF)

A posterior lumbar interbody fusion (PLIF) is performed to remove a disc that is the source of back or leg pain and fuse spinal vertebrae with bone grafts. It is called a posterior procedure because the spine is approached through an incision on the back. Instrumentation is used to provide space for placing the grafts and to help stabilize the spine.

Learn more by visiting the page, Posterior Lumbar Interbody Fusion (PLIF)

Minimally invasive PLIF

In patients with spinal instability, instrumentation is used to provide space for placing the grafts and to help stabilize the spine. Using a technique known as minimally invasive surgery (MIS), posterior lumbar interbody fusion can, in some patients, be done with a much smaller incision than traditional open spinal surgeries and avoids damaging the low back muscles.

Learn more by visiting the page, Posterior Lumbar Interbody Fusion (PLIF)

Transforaminal lumbar interbody fusion (TLIF)

As in the posterior lumbar interbody fusion (PLIF) procedure, a bone graft is used to fuse the spinal vertebrae after the disc is removed. However, the TLIF procedure places a single bone graft between the vertebrae from the side, rather than two bone grafts from the rear, as in the PLIF procedure. Inserting the graft from the side where the facet joint has been removed is an effort to avoid moving or damaging nerve roots during the procedure.

Minimally invasive TLIF

In patients with spinal instability, instrumentation is used to help stabilize the spine during the bone graft fusion. Using minimally invasive surgery (MIS), transforaminal lumbar interbody fusion can be done in certain patients with a much smaller incision than traditional open spinal surgeries, decreasing damage to the low back muscles.

Anterior lumbar interbody fusion (ALIF)

This surgery is performed to remove a large portion of a degenerated disc that is frequently the source of back or leg pain. This procedure makes space between the vertebral bodies, relieving pressure and creating more room for spinal nerves to exit. It is called an anterior procedure because the spine is approached from the front. Unlike posterior approaches (from the back), the anterior approach avoids damage to the low back muscles. The removed disc portion is replaced with implanted bone grafting materials, and adjacent vertebral bodies fuse to provide support.

Lateral lumbar interbody fusion (LLIF)

This procedure, also known as lateral access spine surgery, is a minimally invasive surgery that accesses the spine from incisions on the side of the body. This procedure avoids separating the low back muscles, cutting bone, or moving aside blood vessels as required for other minimally invasive spine fusion procedures (PLIF, TLIF, ALIF). Lateral access spine surgery can treat a variety of conditions including herniations, asymmetric disc degeneration (degenerative scoliosis), nerve impingement, certain tumors, and as discussed in this animation, instability and pain resulting from disc degeneration.

Authors

    Select research articles on lumbar interbody fusion

    • Alluri R, Mok JK, Vaishnav A, Shelby T, Sivaganesan A, Hah R, Qureshi SA. Intraoperative Neuromonitoring During Lateral Lumbar Interbody Fusion. Neurospine. 2021 Sep;18(3):430-436. doi: 10.14245/ns.2142440.220. Epub 2021 Sep 30. PMID: 34610671; PMCID: PMC8497239.
    • Derman PB, Albert TJ. Interbody Fusion Techniques in the Surgical Management of Degenerative Lumbar Spondylolisthesis. Curr Rev Musculoskelet Med. 2017 Dec;10(4):530-538. doi: 10.1007/s12178-017-9443-2. PMID: 29076042; PMCID: PMC5685965.
    • Manzur M, Virk SS, Jivanelli B, Vaishnav AS, McAnany SJ, Albert TJ, Iyer S, Gang CH, Qureshi S. The rate of fusion for stand-alone anterior lumbar interbody fusion: a systematic review. Spine J. 2019 Jul;19(7):1294-1301. doi: 10.1016/j.spinee.2019.03.001. Epub 2019 Mar 11. PMID: 30872148.
    • Manzur MK, Steinhaus ME, Virk SS, Jivanelli B, Vaishnav AS, McAnany SJ, Albert TJ, Iyer S, Gang CH, Qureshi SA. Fusion rate for stand-alone lateral lumbar interbody fusion: a systematic review. Spine J. 2020 Nov;20(11):1816-1825. doi: 10.1016/j.spinee.2020.06.006. Epub 2020 Jun 11. PMID: 32535072.
    • Pawar A, Hughes A, Girardi F, Sama A, Lebl D, Cammisa F. Lateral Lumbar Interbody Fusion. Asian Spine J. 2015 Dec;9(6):978-83. doi: 10.4184/asj.2015.9.6.978. Epub 2015 Dec 8. PMID: 26713134; PMCID: PMC4686408.
    • Salzmann SN, Fantini GA, Okano I, Sama AA, Hughes AP, Girardi FP. Mini-Open Access for Lateral Lumbar Interbody Fusion: Indications, Technique, and Outcomes. JBJS Essent Surg Tech. 2019 Nov 1;9(4):e37.1-10. doi: 10.2106/JBJS.ST.19.00013. PMID: 32051785; PMCID: PMC6974316.
    • Salzmann SN, Shue J, Hughes AP. Lateral Lumbar Interbody Fusion-Outcomes and Complications. Curr Rev Musculoskelet Med. 2017 Dec;10(4):539-546. doi: 10.1007/s12178-017-9444-1. PMID: 29038952; PMCID: PMC5685966.
    • Swiatek PR, McCarthy MH, Weiner J, Bhargava S, Vaishnav AS, Iyer S. Intraoperative image guidance for lateral position surgery. Ann Transl Med. 2021 Jan;9(1):90. doi: 10.21037/atm-2020-ioi-10. PMID: 33553383; PMCID: PMC7859765.
    • Weiner JA, McCarthy MH, Swiatek P, Louie PK, Qureshi SA. Narrative review of intraoperative image guidance for transforaminal lumbar interbody fusion. Ann Transl Med. 2021 Jan;9(1):89. doi: 10.21037/atm-20-1971. PMID: 33553382; PMCID: PMC7859762.
     

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