The Multilevel Spinal Fusion Surgery

Fusion of the spine refers to removing motion around or through a disc space by creating a bone bridge from one vertebra to the next. Fusion can be accomplished through several ways. The most common approaches are:

  • Interbody fusion. When the fusion is done through the disc space it is called an interbody fusion. The interbody fusion can be accomplished through several approaches, including:
    • Through the front of the spine (anterior lumbar interbody fusion, or ALIF),
    • From the side of the spine (extreme lateral interbody fusion, or XLIF)
    • From the posterior aspect of the spine (transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF)).
  • Posterior or posterolateral fusion. This approach is done through the back and focuses on connecting portions of the posterior (in the back of the spine) bony elements of the spine. This may also be referred to as a facet fusion.

In some cases, both interbody and posterior fusions are performed at the same time. Each type of spinal fusion has specific indications as well as specific risks and benefits, and each type may be done at more than one level of the spine.

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Techniques involved in multilevel spinal fusions are similar to those of single-level fusions for degenerative disc disease. The 'menu' of potential surgical approaches, bone graft options, and cage and instrumentation possibilities are the same as for one level fusions.

This includes posterior approach only, anterior approach only, or a combined anterior and posterior approach surgery, which is more common in multilevel fusions. Most multilevel fusion procedures involve the use of spinal instrumentation in the back of the spine, but may also include supplemental anterior fixation as well.

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