Spine Fusion – Cervical, Thoracic & Lumbar

At the Advanced Center for Orthopedics and Plastic Surgery, our specialty-trained orthopedic spine surgeon Dr. Warlick is highly skilled in performing cervical, thoracic and lumbar spinal fusions (also known as neck and back spinal fusions). The Advanced Center for Orthopedics and Plastic Surgery has been performing spinal fusions for more than three decades. That means your spine surgery will be performed by a team whose experience and skill-set is virtually unmatched in Marquette, the surrounding Upper Peninsula, and throughout Northern Michigan.

Anterior Cervical Fusion (ACDF)

In the anterior approach to cervical fusion (also known as anterior cervical discectomy and fusion, or ACDF), the spine surgeon creates a one to two-inch incision along the neck crease in the front of the neck, allowing access to the disc space. The diseased or damaged disc is carefully removed, along with any disc herniation or bone spurs that are pressing on the nerves or spinal cord. A small cage and/or bone graft is placed in the vacant space to maintain room for the nerves, and stabilize the spine. The surgeon then screws a very small metal plate over the bone graft to hold the bones in place while the vertebrae heal. This procedure can be performed at one or multiple levels of the cervical spine. A neck brace is often used for a short period of time after surgery. For many patients, this can help improve arm and leg function, and can also improve neck pain, arm pain, numbness, and weakness. Early ambulation is encouraged immediately following the procedure. This may be performed as an outpatient procedure, with some patients going home the same day as surgery.

Instrumented Posterior Spinal Fusion (IPSF)

In the posterior approach to spinal fusion (also known as instrumented posterior spinal fusion, IPSF), the spine surgeon creates an incision along the middle of the back or neck. In order to view the vertebra that is to be fused, the surgeon carefully pulls back the muscles that cover the spine, and removes the affected joints of the spine. Bone graft material, screws and rods are positioned along the sides of the vertebrae to stabilize the spine, and promote healing. The bone graft binds the vertebra together, forming a new bone mass called a fusion. This procedure can be performed in one or more levels of the cervical (neck), thoracic (mid back), or lumbar (low back) spinal areas. It can be used to treat degenerative conditions of the spine, spinal arthritis, fractures, or deformity (including scoliosis). The posterior spinal fusion procedure can be performed alone, but is often combined with other spinal procedures, such as a laminectomy, in order to take pressure off of the nerves in the spine. A brace is often used for a short period of time after surgery. For many patients, this can help improve spine pain, as well as arm and/or leg pain, numbness, weakness and function. Early ambulation is encouraged immediately following the procedure.

Posterior Lumbar Interbody Fusion (PLIF)

In the posterior approach to lumbar interbody fusion (PLIF), the spine surgeon creates an incision along the middle of the lower back. In order to view the vertebra that is to be fused, the surgeon carefully pulls back the muscles that cover the spine, and removes the arthritic bone and/or irritated disc that is putting pressure on the spinal nerves. Through the back of the spinal canal, a cage and bone graft are placed into the empty disc space to realign the vertebral bones. This maintains room for the nerves, and stabilizes the spine. Screws and rods are positioned along the sides of the vertebrae to provide additional support, and promote healing. The bone graft binds the vertebra together, forming a new bone mass called a fusion. The PLIF procedure can be performed alone, or in addition to other spinal procedures. A brace is often used for a short period of time after surgery. For many patients, this can help improve spine pain, as well as leg pain, numbness, and weakness. Early ambulation is encouraged immediately following the procedure.

Open Transforaminal Lumbar Interbody Fusion (TLIF)

In the open transforaminal approach to lumbar interbody fusion (TLIF), the spine surgeon creates an incision along the middle of the lower back. In order to view the vertebra that is to be fused, the surgeon carefully pulls back the muscles that cover the spine. The surgeon then removes the arthritic joint and irritated disc of the spine that is putting pressure on the spinal nerves. Through the same pathway, a cage and bone graft are placed into the empty disc space to realign the vertebral bones. This maintains room for the nerves, and stabilizes the spine. Screws and rods are positioned along the sides of the vertebrae to provide additional support, and promote healing. The bone graft binds the vertebra together, forming a new bone mass called a fusion. The TLIF procedure can be performed alone, or in addition to other spinal procedures. A brace is often used for a short period of time after surgery. For many patients, this can help improve spine pain, as well as leg pain, numbness, and weakness. Early ambulation is encouraged immediately following the procedure.

Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF)

In the minimally invasive surgical approach to transforaminal lumbar interbody fusion (TLIF), the spine surgeon uses intraoperative video X-ray images (fluoroscopy) to view the affected spine bones and disc. A small incision is made just to the right or left side of the middle of the low back, and a tube is placed through the low back muscles to allow access to the vertebra. Through this working tube, the surgeon removes the arthritic joint and irritated disc of the spine that is putting pressure on the spinal nerves. Through the same pathway, a cage and bone graft are placed into the empty disc space to realign the

vertebral bones. This maintains room for the nerves, and stabilizes the spine. An identical incision is then made on the other side of the low back. Through these small incisions, fluoroscopy is again used to guide placement of screws and rods along the sides of the vertebrae in order to provide additional support, and promote healing. The bone graft binds the vertebra together, forming a new bone mass called a fusion. The MIS-TLIF procedure can be performed alone, or in addition to other spinal procedures. A brace is often used for a short period of time after surgery. For many patients, this can help improve spine pain, as well as leg pain, numbness, and weakness. Early ambulation is encouraged immediately following the procedure.

Lateral Lumbar Interbody Fusion (LLIF)

The lateral approach to lumbar interbody fusion (also known as LLIF, DLIF, or XLIF) is a minimally invasive surgery technique for spinal fusion. In this approach, the patient is placed on their side in the operating room. The spine surgeon uses intraoperative video X-ray images (fluoroscopy) to view the affected spine bones and disc. The spine surgeon makes a two to three-inch incision on the patient’s side, usually between the ribs and hip. The pathway between the patient’s abdomen and low back muscles is carefully opened, allowing access to the side of the vertebra that is to be fused. The spine surgeon then removes the arthritic bone and/or irritated disc that is putting pressure on the spinal nerves. Through the same pathway, a cage and bone graft are placed into the empty disc space to realign the vertebral bones. This maintains room for the nerves, and stabilizes the spine. The bone graft binds the vertebra together, forming a new bone mass called a fusion. While still asleep, the patient is then usually turned face down in the operating room, and fluoroscopy is again used to guide placement of screws and rods along the sides of the vertebrae through a series of small incisions over the low back. This provides additional support, and promotes bone healing. The LLIF procedure can be performed alone, or in addition to other spinal procedures, and is often used to treat a degenerative disc, spine arthritis, spinal deformity (scoliosis), and/or spinal stenosis. A brace is often used for a short period of time after surgery. For many patients, this can help improve spine pain, as well as leg pain, numbness, and weakness. Early ambulation is encouraged immediately following the procedure.

Anterior Lumbar Interbody Fusion (ALIF)

In the anterior approach to lumbar fusion (ALIF), the spine surgeon often works with a general or vascular surgeon to gain access to the front of the spine. The surgeon makes a three to five-inch incision down the center of the lower abdomen. The organs and blood vessels are gently moved to the side in order for the surgeon to view the front the spine. This allows for the treatment of damaged discs and bone, without directly touching or moving the irritated spinal nerves. After the damaged disc is removed, a cage filled with bone graft material is positioned into the empty disc space. This helps to realign the vertebral bones, lifting pressure from the pinched nerve roots. The surgeon then places screws through a small metal plate in front of the cage and bone graft, which holds the bones in place while the vertebrae heal. Occasionally, depending on a patient’s situation, additional support may be needed for healing. In such a situation, intraoperative video X-ray (fluoroscopy) is used to guide placement of screws and rods along the back sides of the vertebrae through a pair of small incisions over the low back. The ALIF procedure can be performed alone, or in addition to other spinal procedures, and is often used to treat a degenerative disc, spine arthritis, spinal deformity (scoliosis), and/or spinal stenosis. A brace is often used for a short period of time after surgery. For many patients, this can help improve spine pain, as well as leg pain, numbness, and weakness. Early ambulation is encouraged immediately following the procedure.

General Considerations

Spinal fusions are major surgical procedures that require the patient to be under general anesthesia. This means you won’t be awake for surgery and will therefore be comfortable and feel no pain during surgery. While most spinal fusions require at least one-night hospital stay, a select few patients may be able to go home on the same day as surgery. Early ambulation is always recommended and encouraged, starting on the day of surgery. A brace is often used for a short period of time after surgery to assist with comfort, and to maintain spinal alignment. Although every surgery is unique, most patients should expect some pain after surgery. Pain medication is given for a short period of time after surgery, and refilled only as needed. The Advanced Center for Orthopedics and Plastic Surgery strictly follows state and local regulations regarding pain medication prescriptions. Most patients stop taking pain medication between one and six weeks after surgery. Over the counter acetaminophen (Tylenol) is often recommended to be taken as needed, once narcotic pain medication is no longer required. Because spinal fusions typically involve opening major muscle groups to access the affected vertebrae, patients typically need to undergo a recuperation process involving clinic follow-up care and physical therapy that may last up to several months. Patients are typically seen back in the spine clinic at two weeks, six weeks, and three months after surgery. Duration of bracing and activity restrictions that may delay return to work or sport are discussed at each visit. Additional follow up and treatments may be needed, depending on the patient’s individual situation and what the spine surgeon thinks is best.

To learn more about what to expect when you undergo spinal surgery, and ways to optimize your outcome, please visit the Michigan Spine Surgery Improvement Collaborative (MSSIC) website at https://mssic.org/resources/patient-resources/

Additional information for patients is available through our surgery prep and recovery page and interactive videos.

Specialty Reference:

Spine