Interbody Fusion: An Alternative to Severe and Chronic Back Pain

Most people with back pain and injuries can find relief with rest, exercise, stretching and muscle-building activities, braces, anti-inflammatory medications, and time for the body to heal itself. However, sometimes the damage is too great and the pain too much to bear. In cases of severe disc degeneration, herniated disk, scoliosis, spinal fractures, and instability of the spine that have not responded to other non-surgical treatments, fusion surgery may be necessary.

Called “interbody fusion,” such surgery involves actually joining or fusing two or more vertebrae together. To date, there are four different types of fusion procedures available, each with modern-day advances that help minimize surgical incisions and hospital stays, and encourage faster recovery.

Surgery from the Back

            Posterior lumbar interbody fusion (PLIF) is a procedure in which the surgeon works from the back to make corrections in the spine. Discs that have degenerated (or worn out) may be pressuring the nerves in the spinal column, causing pain, while ligaments may have become weak, decreasing vertical height. The doctor makes an incision in the back, separates the muscles to reach the vertebrae, removes the offending disc if necessary, trims away bone spurs and anything else that may be encroaching upon the nerves, then goes to work on the bone. Usually, he will insert a spacer implant (often called a “cage”) into the space left by the defective disc. The implant can be made from bone, bone substitute, metal, or other material, and holds the vertebrae apart while encouraging the bone to fuse together, stabilizing the spine and relieving pain.

            The surgeon may also help fix the bone in place using screws. The end goal is to make sure the vertebrae no longer move against one another, and function as one unit instead, eliminating pain that was caused by the damaged disc and compressed nerves. Further damage, as well, is less likely to occur.

Variations on a Theme

            Depending on the condition of the spinal discs and their location, a variation on the PLIF surgery may be used. Transforaminal lumbar interbody fusion (TLIF), for example, still approaches the spine from the back, but more from the side of the spinal canal, reducing the need for separation of the muscles and disturbance of the nerves. Surgeons typically use an endoscope (camera at the end of a long, narrow tube) to complete the surgery. Because the surgeon can typically see more during a TLIF, a larger bone graft can be used, helping to better re-align the spine.

            Anterior lumbar interbody fusion (ALIF) seeks to accomplish the same goal as the other two surgeries, but approaches the spine from the front instead of the back, and is an option for patients with more stable spines. The incision is made in the lower abdominal area, causing little disturbance to the back muscles and less post-operative pain.

            Finally, extreme lateral interbody fusion (XLIF)—a relatively new procedure—involves an incision on the patient’s side, avoiding an abdominal incision and still leaving the back muscles untouched. Again, recovery time is faster and pain less troublesome, but the procedure can be used only on those vertebrae easily accessed from the side of the body.

After Surgery

            Recovery after infusion surgery can take some time. Patients stay in the hospital for up to one week, working with a physical therapist to learn safe ways to move, dress, and do other activities without straining the back. Once patients return home, outpatient physical therapy helps rebuild muscles and movement.

            If you’re experiencing severe or chronic back pain and feel you may be a candidate for interbody fusion, call Dr. Katz’s office today for a consultation.