Introduction

Lateral lumbar interbody fusion (LLIF) is a minimally invasive surgical technique used to repair spinal instability and relieve pain caused in the lower back and legs when physical therapy is not an option anymore. This technically demanding procedure involves fusing two or more vertebrae, called lumbar fusion, in the lumbar region of the spine, often using bone morphogenetic protein or bone marrow aspirate (BMA) to promote solid fusion. This helps to stabilize the spine and alleviate symptoms by relieving pressure on the nerves with minimal damage to adjacent tissues, less tissue disruption, and damage to the facet joints and soft tissues.

Traditional procedures involve fusing the bones of the back of the spine. During an LLIF, the Dallas lateral lumbar interbody fusion surgeon inserts instruments from the patient’s side, accessing the spine through a small incision while the patient lies on the operative table, often using dilator tubes and an operating microscope to minimize muscle disruption. The bones are then fused from the front of the spine, where there is a larger surface area for fusion to occur.

This minimally invasive technique involves removing the disc at the affected level and replacing it with a spacer (or cage), often filled with bone graft material taken from the iliac crest (bone harvested) or mixed with bone marrow aspirate (BMA) or sourced from a bone bank, that restores adequate height between the adjacent vertebrae (affected vertebrae), takes the pressure off the nerves, and improves spinal alignment to the correct position. The fusion carries the benefit of forming a solid mass as new bone grows and healing occurs, stabilizing the vertebra firmly and supporting spine health.

Lateral lumbar interbody fusion (LLIF) is commonly used to address spinal disorders involving the intervertebral discs, particularly in cases of nerve compression causing painful motion and other painful conditions. Restoring disc height in the lumbar portion can help relieve nerve pressure and create the stability needed for a successful fusion, as confirmed by follow-up imaging such as chest X-ray, other imaging tests, or fluoroscopy.

Benefits of Lumbar Lateral Interbody Fusion (LLIF) Surgery

This spinal fusion surgery provides several benefits for patients suffering from lower back pain, including those with prior abdominal surgery. The procedure can relieve pressure on the nerves, which can help to reduce pain in the legs and lower back, often managed with pain medicine during recovery. This minimally invasive procedure accelerates recovery time for patients and minimizes muscle disruption during surgery. Some additional benefits of the direct lateral approach include:

Pain relief
Improved posture
Restoration of spinal alignment and lumbar lordosis
Lower risk of nerve (particularly to the lumbar plexus) and major muscle damage compared to spinal fusion performed from the back of the spine
High lateral lumbar interbody fusion success rate

For most one- and two-level lumbar problems, a well-executed lateral fusion is a better construct than a TLIF. I chose this approach because the data supports it — not because it’s the easiest option.

Patients who would benefit from Lateral Lumbar Interbody Fusion

Lateral lumbar interbody fusion is often recommended for patients who have:

Degenerative disc disease for levels L4/5 and above: This is a condition in which the discs between the vertebrae break down, leading to nerve damage, compression, and back pain. Lateral lumbar interbody fusion treats degenerative disc disease by stabilizing the spine and promoting bone fusion through minimally invasive surgery.
Spinal stenosis (including lumbar spinal stenosis): This is a condition in which the spinal canal narrows, putting pressure on the nerves.
Flat back: This is a condition in which the lumbar spine lacks appropriate lordosis (curvature)
Failed back surgery: This occurs when patients have had prior spine surgery but still experience pain. Often, this pain is due to improper spinal alignment, failure of fusion, or problems at the levels above or below the previous spine surgery.
Spondylolisthesis: This condition in which one vertebra slips forward over the vertebra below it. It can be caused by aging, injury, or degenerative disc disease. It is appropriate for select patients with degenerative spondylolisthesis because it restores alignment and stability.
Recurrent herniated discs: A herniated disc occurs when the gel-like center ruptures through the outer layer. This can put pressure on the nerves and cause pain.
Scoliosis: This is a condition in which the spine has abnormal curvature, which leads to pain.
Adjacent segment disease: This is a medical condition in which the levels above or below a previous fusion begin to break down and cause problems.

Before undergoing an LLIF surgical procedure, you should let your Dallas Lateral Lumbar Interbody Fusion specialist know if you have any of the following:

History of spinal infections
History of aortic aneurysm repair
History of any abdominal surgery

Procedure

The spine surgeon accesses the spine from the side of the patient. The first portion of the lateral lumbar interbody fusion surgery involves getting access to the front of the spine using surgical instruments, which is accessed via a small incision on the left flank near the incision area.

As a Dallas Lateral Lumbar Interbody fusion doctor approaches the spinal cord, neuromonitoring technology is used to ensure there will be no spinal nerve injury during the surgery. This procedure is performed in the operating room under general anesthesia, with vital signs closely monitored throughout. Once the spine can be visualized, the LLIF is completed using the following steps:

The Dallas Lateral Lumbar Interbody Fusion surgeon removes the disc between the affected levels of the spinal column. The cartilage on the top and bottom of the vertebrae is scraped off, preparing the bones for optimal fusion.

Different sizes of spacers (cages) are placed into the empty disc space using increasingly larger dilators until the correct size is determined for better bone healing. An X-ray machine is used during this portion of the surgery to ensure the best fit of the spacer in the disc space for each patient, while neuromonitoring technology helps prevent nerve injury.

Spacers can be made of different materials, but often are a 3D printed titanium cage. Before placement in the patient’s disc space, the cage is filled with spacer bone graft material. The spine specialist carefully places the cage between the vertebrae. X-rays are taken to ensure satisfactory placement of the cage.

The surgical site on the patient’s flank is then closed with absorbable suture, and a dressing is placed to keep the incision site clean and dry as part of postoperative care.

The surgery typically takes two to three hours to complete under general anesthesia, during which the patient will be asleep. After the surgery is completed, the patient will be taken to a recovery room, where their vital signs will be closely monitored. Most patients will have a 1 to 2-day hospital stay after surgery, during which postoperative care includes avoiding smoking, driving, or lifting heavy things, and starting physical therapy as directed by the surgeon.

Almost always, this surgical technique is paired with posterior instrumentation and extreme lateral interbody fusion or direct lateral interbody fusion, which will be discussed separately.

Postoperative care will include arranging a follow-up appointment with your doctor to monitor healing and confirm that the bone fuses properly, stabilizing the spine and providing life-changing relief through improved spine care.

Risks and postoperative complications associated with minimally invasive LLIF

In general, the risks associated with lumbar lateral interbody fusion are rare. However, patients should be aware of all risks involved and discuss the following before surgery with the spine physician:

Damage to Large Blood Vessels
Lateral lumbar interbody fusion is done near large and major blood vessels. There is a risk of damage or injury to these vessels, leading to blood loss, blood clots, or deep vein thrombosis. However, this complication is rare. These risks are considered early postoperative complications and are monitored closely during the hospital stay.
Damage to Abdominal Organs
The surgical path of lateral lumbar interbody fusion is close to the abdominal organs such as the bladder, kidneys, colon, and ureter. There is a small risk of damage to the abdominal cavity or abdominal wall, , and the procedure requires post operative care to monitor for complications such as muscle spasms or issues related to metal implants used for stabilization.
Migration of the cage
In rare cases, the cage placed between the bones can move. This can lead to problems with healing and may require revision surgery. With the modern surgical approach, the risk of this is nearly eliminated. Once the cage is stable, the body begins healing as the spinal bones gradually fuse over time.
Leg pain
Sometimes, the nerves can be irritated in the psoas muscle, causing pain on the side of the skin incision, which may affect the genital area. This anterior thigh pain is usually transient and often resolves in days to weeks with the help of proper postoperative care, including taking pain medications as recommended by your doctor. This irritation can occur in patients who are being treated for conditions such as disc herniation or adult degenerative scoliosis, where the goal of surgery is often to relieve nerve pinching. Experience with lateral lumbar fusions correlates with lower complication rates, and board-certified surgeons with specialized skills perform these procedures using intraoperative electromyography for nerve monitoring to minimize such risks.

It’s also helpful for patients to understand that LLIF is one type of lateral fusion, and other minimally invasive approaches may be recommended depending on anatomy and goals, such as Oblique Lumbar Interbody Fusion (OLIF), Transforaminal Lumbar Interbody Fusion (TLIF), Direct Lateral Interbody Fusion (DLIF), or Anterior Lumbar Interbody Fusion (ALIF).

This isn’t something I do occasionally. Single-position prone LLIF has been my exclusive approach to lateral fusion since 2022. Every lateral fusion patient in my OR receives this technique.

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Reach Out to A Dallas Lateral Lumbar Interbody Fusion Surgeon Today

If you are dealing with persistent pain that has not improved with physical therapy, it may be time to speak with experienced spine surgeons about your options for lateral lumbar fusion.

For most patients, a minimally invasive LLIF procedure is designed to treat disc problems such as degenerative disc disease and spinal stenosis and can provide an effective solution with less disruption to surrounding muscles and tissues, including avoiding damage to major back muscles, especially when other treatments are no longer providing relief. This surgery may also be recommended if you experience impaired bowel or bladder function.

Dr. Michael R. Wheeler, a Dallas Lateral Lumbar Interbody Fusion surgeon, can help you determine whether an LLIF procedure is appropriate for your spine condition and goals, including whether a one-level or multi-level fusion is needed, and guide you through each step of care, from evaluation through recovery. Contact Dr. Michael R. Wheeler for a consultation today.

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RECOVERY

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