What it is
Lumbar interbody fusion performed through an anterior approach to the front of the spine, an open posterior approach, or a combination. These are the larger-access operations, used where the goals exceed what can be achieved through small incisions.
Who it is for
Significant loss of disc height or lordosis, flat-back deformity, multi-level degeneration, pseudarthrosis after a previous fusion, high-grade spondylolisthesis, and revision cases where scar tissue makes a posterior-only approach hazardous.
How it works
For an anterior fusion, an approach surgeon helps reach the front of the spine through the abdomen, moving vessels and viscera aside. The disc is removed completely and a large cage restores height and lordosis. For an open posterior fusion, a midline incision exposes the levels for direct decompression, pedicle screws and posterolateral graft. The two are often combined for correction and stability.
Recovery
Usually two to three nights, longer for combined or multi-level procedures. Anterior approaches bring abdominal discomfort and a temporary slowing of bowel function. Walking begins early. Return to desk work is commonly six weeks; fusion consolidates over three to six months and is followed radiologically.
Risks and alternatives
In addition to the general risks of fusion: injury to the great vessels, bowel or ureter in anterior approaches — uncommon but serious — and retrograde ejaculation in men after an anterior L5–S1 exposure, which should be discussed before consenting. Alternatives include minimally invasive fusion, lateral approaches, or decompression alone where stability permits.