The ABCs of Spinal Fusion Surgery: ALIF, PLIF, and TLIF

Spinal fusion surgery refers to several different types of surgeries commonly performed to treat certain spinal disorders. The University Spine Center may recommend spinal fusion surgery to treat degenerative disc disease, scoliosis, spondylolisthesis, and fracture. Some of the most common types of fusion surgery are identified by initials: LIF, ALIF, PLIF, and TLIF.

LIF: Lumbar Interbody Fusion

LIF combines fuses two or more vertebrae together and implants an interbody device, around which a bone graft is packed. The bone graft helps to stimulate the process of fusion.

Bone graft may be

  • Autograft (from patient)
  • Allograft (from donor)
  • Bone morphogenetic protein (which may be synthetic)

ALIF: Anterior Lumbar Interbody Fusion

ALIF is an LIF procedure done when the surgeon approaches the spine through the anterior (front) of the body and works on anterior of the spine.

ALIF is often used to perform a discectomy (removal of a disc in the lower back). An interbody device of some sort is implanted and bone graft is packed around the area to stimulate fusion.

PLIF: Posterior Lumbar Interbody Fusion

The PLIF procedure is similar to an ALIF except that it treats the posterior (back) portion of the spine. PLIF is typically used to treat degenerative diseases of the lower back, such as scoliosis or spondylolisthesis.

The PLIF procedure typically involves a laminectomy. The laminae (singular: lamina) is a bony portion of the vertebra bone. In a laminectomy, the laminae are trimmed, sometimes including nearby facet joins in order to relieve pressure or compression on the nerve roots, disc, and spinal canal.

After the laminectomy, a discectomy is performed in which the vertebrae are separated in order that the damaged disc is removed. This, too, relieves pressure on nerves and the spinal canal. An interbody device is then implanted in place of the disc so that the spine retains the same shape. A bone graft is then added to stimulate fusion.

TLIF: Transforaminal Lumbar Interbody Fusion

A TLIF fuses both anterior and posterior of the spine. The anterior may be stabilized with an interbody device and bone graft, while the posterior is stabilized with an implant device and bone graft.

XLIF or DLIF: Extreme Lateral Interbody Fusion or Direct Lateral Interbody Fusion

In these two procedures, the surgeon accesses the spine from the side (lateral) and gently pushes aside the muscles and tendons to perform the interbody fusion. The advantage to a lateral approach is that there is less damage to the muscles and tendons of the back, which promote a speedier recovery.

How Are These Procedures Performed?

These procedures may be performed as an open operation (major surgery) or a minimally invasive procedure (small incision). An ALIF may also be performed as a “mini-open” procedure. The University Spine Center will recommend the appropriate surgical approach based on your condition, medical history, spinal disorder, and the surgeon’s discretion.

After Fusion Surgery

Recovery is different for every patient. However, most patients are up and walking by the end of the first day after surgery. Most patients can expect to stay in the hospital for three to five days, depending on their condition.

When discharged, patients are given a prescription for pain medication to be taken as needed. The University Spine Center team will provide home care instructions, including a detailed postoperative physical therapy and exercise plan to help ease recovery.