Lumbar Interbody Fusion

Lumbar Interbody Fusion is a routine surgical procedure to treat lower back pain and compression of nerves. In addition, it is utilized to restore the overall alignment of the spine by joining two or more vertebrae. It involves placement of a spacer (cage) containing bone material between the bones of the spine which serves as a conduit for the bones to heal and unite. This is further reinforced with screws to allow the union. It may be performed with a decompression laminectomy if compression on the nerves is coexistent.

Indications for Lumbar Interbody Fusion

Lumbar interbody fusion is considered when symptoms do not improve with non-surgical treatment. It is used to treat nerve compression, instability, or spinal alignment issues.

• Severe Nerve Compression via slipped discs or spinal stenosis
• Instability.
• Excessive movement of the bone of the spine over each other(Spondylolisthesis)
• Deformity
• Adjacent segment disease

Types of Lumbar Interbody Fusions

There are several approaches to lumbar interbody fusion, each chosen based on the patient’s condition and surgical goals.

Minimally Invasive Transforaminal Interbody Fusions(MIS-TLIF)

This is the preferred method of Dr Mark Tan BH to perform “keyhole” posterior interbody fusions.

Benefits include

• Decreased wound size for cosmesis
• Decreased muscle dissection
• Decreased postoperative pain
• Faster recovery times
• Shortened hospital stays.

The procedure involves two 2-3 cm incisions on either side of the midline on the back. Specialized tubular retractors are used to spread muscle fibers exposing the posterior bony aspect of the spine. Removal of bony spurs and lamina bone from the posterior aspect of the spine provides space for the nerves. The intervertebral disc is removed and replaced with a cage containing bone graft to expedite healing between the vertebral bones. Screws are inserted to secure the bones to facilitate union via the same incisions.

Open Transforaminal Interbody Fusions (TLIF)

TLIFs can also be  performed via an open technique. The procedure involves a midline incision over the posterior aspect of the spine. Removal of bony spurs and lamina bone from the posterior aspect of the spine provides space for the nerves. The intervertebral disc is removed and replaced with a cage containing bone graft to expedite healing between the vertebral bones. Screws are inserted to secure the bones to facilitate union.

This method is usually performed when the pre-existing deformity is severe.

Anterior and Lateral Interbody Fusions

Occasionally, anterior and lateral interbody fusions may be required. Access to the space between the bones is achieved with incisions over the side or front of the abdomen. Additional incisions are required over the back for screw insertion for securing the bones and graft to achieve union.

This method may be required in revision surgery or complex deformity correction.

Planning the Right Surgical Approach

The surgical approach is chosen based on the patient’s condition, spine alignment, and overall health. Dr. Mark Tan BH considers both symptoms and scan results when planning treatment.

Minimally invasive methods like MIS-TLIF are often used for isolated nerve compression or instability. Open TLIF may be needed for more severe deformities. In some cases—such as repeat surgeries or complex spine problems—anterior or lateral approaches may be more suitable.

Each method is chosen to treat the condition effectively while reducing unnecessary impact on surrounding tissue.