Surgical procedure’s description of the lumbar intervertebral fusion methods.
| Surgical Procedure | Description |
| ALIF | The ALIF technique consists of an anterior retroperitoneal approach that provides access to the disc, with the patient in supine position. It involves a 3- to 5-inch midline and paramedian incision, the opening of the longitudinal ligament, and an important vascular mobilization, leaving the paraspinal muscles intact.2,3 This approach allows the insertion of a cage that covers the entire endplate surface, including the apophyseal ring, which stabilizes the motion segments, which may not require adjunct pedicle screws. |
| LLIF | LLIF is performed by a lateral retroperitoneal incision on a laterally positioned patient. This creates a transpsoas corridor to access the disc space and insert the implant.2 Like the cages used in ALIF, the LLIF implant is placed medially and has a large footprint covering parts of the apophyseal ring. |
| OLIF | The OLIF surgery requires patients to be positioned on their side. It involves a lateral and paramedian incision between the peritoneum and the psoas muscle to access the disc space.2 A smaller implant than for ALIF and LLIF is inserted, covering the interior one-third portion of the endplate. It will rarely cover the apophyseal ring and mostly be used in conjunction with posterior fixations. |
| PLIF | PLIF, one of the first procedures used for IVD fusion surgery, accesses the IVD space from a posterior direction with the patient in a prone position. A midline incision dissecting bilateral muscle strip or splitting paramedian muscle is performed. Before inserting the cage, a laminectomy and a partial facetectomy are performed to navigate around nerve roots.4 Depending on the cage design, 1 or 2 cages are inserted within the apophyseal ring.2–4 |
| TLIF | The transforaminal TLIF provides access to the intervertebral space directly through a small unilateral incision on 1 side of the neural foramen while the patient is in prone position, minimizing nerve manipulation.2 This may involve extensive muscle retraction and dissection with the removal of the facet joint in order to place a straight or curved cage. TLIF cages have significantly smaller footprint coverage than ALIF and LLIF cages.3,5 Depending on the cage used and the surgeon’s approach, the TLIF cage can either be placed on the interior or medial part of the endplate. TLIF does not provide enough segmental stability without the use of posterior fixation. |
Abbreviations: ALIF, anterior lumbar interbody fusion; IVD, intervertebral disc; LLIF, lateral lumbar interbody fusion; OLIF, oblique lumbar interbody fusion; PLIF, posterior lumbar interbody fusion; TLIF, transverse lumbar interbody fusion.