Lumbar Procedures

Thoracolumbar Deformity Correction/Scoliosis Correction

  • Surgical correction of scoliosis is typically recommended for patients with progressive spinal deformity that causes pain, loss of function, postural imbalance, or neurologic symptoms. In adults, indications often include disabling back or leg pain due to spinal stenosis, sagittal or coronal imbalance, or degenerative scoliosis that worsens over time. In adolescents, surgery may be indicated for curves greater than 45–50 degrees that are likely to progress. The goal is to improve spinal alignment, relieve nerve compression, and restore quality of life.

  • Scoliosis correction involves realigning the spine and stabilizing it with implants (typically screws and rods) that span multiple vertebral levels. The surgery is usually performed through a posterior approach, though anterior or lateral approaches may be used in select cases. Deformity correction may involve osteotomies (bone cuts) to mobilize stiff curves and allow for more complete realignment. Once corrected, bone graft material is placed along the spine to promote fusion—creating a solid, stable construct over time.

    The specifics of the procedure—including number of levels fused, need for osteotomies, or approach type—are individualized based on curve severity, flexibility, symptoms, and overall health.

  • While scoliosis surgery can dramatically improve posture, balance, and function, it is a complex procedure and carries significant risks, including:

    • Infection

    • Blood loss (may require transfusion)

    • Nerve injury or spinal cord injury (may lead to weakness or paralysis, though rare)

    • Nonunion (pseudarthrosis)

    • Implant failure or loosening

    • Adjacent segment disease (degeneration above or below the fusion)

    • Medical complications (e.g., cardiac, pulmonary, DVT)

    • Prolonged recovery time

    • Residual pain or stiffness

    Neuromonitoring, meticulous planning, and modern instrumentation help reduce the likelihood of complications.

  • Recovery from scoliosis surgery depends on the extent of correction and the patient’s overall health. Most patients stay in the hospital for 3–7 days. Early mobilization is encouraged with the help of physical therapy. A brace may be used in some cases. Activity restrictions include avoiding bending, lifting, and twisting during the first 3 months to allow for proper fusion. Return to work or school typically occurs within 6–12 weeks, depending on job demands. Follow-up includes X-rays to monitor healing and fusion. Physical therapy may be prescribed to rebuild strength, balance, and endurance over time.

 

Lateral Lumbar Interbody Fusion (LLIF)

  • Lateral lumbar interbody fusion is used to treat degenerative conditions of the lumbar spine, including degenerative disc disease, spondylolisthesis, scoliosis, and spinal instability. It may also be used for revision surgeries or to restore disc height and alignment. Patients may experience chronic low back pain, radiculopathy (leg pain), or symptoms from foraminal or central stenosis that have not improved with conservative treatment.

  • LLIF is a minimally invasive technique that accesses the lumbar spine through the patient’s side (lateral approach), typically through a small incision in the flank. Using specialized retractors and neuromonitoring to avoid injury to the nearby nerves (especially the lumbar plexus), the damaged disc is removed and replaced with a spacer filled with bone graft. The cage restores disc height and opens up the space for the nerves. In many cases, LLIF is combined with posterior instrumentation (screws and rods) for added stability and to promote fusion.

    LLIF allows for a larger interbody graft and can correct spinal alignment with less disruption to muscles and soft tissue compared to traditional posterior approaches.

  • All surgical procedures carry some risk. Risks specific to LLIF may include:

    • Injury to nerves in the lumbar plexus (numbness, thigh pain, or hip flexor weakness)

    • Injury to nearby organs or blood vessels

    • Infection

    • Nonunion (failure of fusion)

    • Implant migration or subsidence

    • Persistent or recurrent pain

    • Need for additional posterior fusion or hardware placement

  • Patients usually stay in the hospital for 1–2 days. Walking is encouraged shortly after surgery, and most patients notice improvement in leg pain fairly quickly. Some patients may experience temporary numbness or weakness in the thigh or hip due to nerve retraction during the approach—this usually improves with time. A brace may be used depending on the extent of surgery and surgeon preference. Activity restrictions generally include avoiding bending, twisting, and heavy lifting for 6 to 12 weeks. Follow-up includes imaging to monitor fusion, and physical therapy may be recommended to help restore core strength and mobility.

 

Transforaminal Lumbar interbody Fusion (TLIF)

  • TLIF is commonly recommended for patients with degenerative disc disease, spondylolisthesis, recurrent disc herniation, spinal instability, or foraminal stenosis causing nerve compression. Symptoms often include chronic low back pain, sciatica (leg pain), numbness, or weakness that have not responded to conservative treatments such as physical therapy, injections, or medications.

  • TLIF is a surgical procedure that stabilizes the lumbar spine by removing the intervertebral disc and fusing two or more vertebrae. It is performed through a posterior (back) approach, with access to the disc space achieved by removing part of the facet joint on one side (the transforaminal route). This allows for safe access to the disc without excessive retraction of the spinal nerves.

    Once the disc is removed, a cage filled with bone graft is placed into the disc space to restore height and alignment. Screws and rods are then placed into the vertebrae to stabilize the spine while the bone graft fuses over time. TLIF provides both direct nerve decompression and mechanical stabilization.

  • As with all spine surgeries, TLIF carries certain risks, including:

    • Infection

    • Bleeding or hematoma

    • Dural tear or cerebrospinal fluid leak

    • Nerve root injury (resulting in numbness, weakness, or pain)

    • Nonunion (failure of the bones to fuse)

    • Implant migration or loosening

    • Adjacent segment degeneration over time

    • Persistent or recurrent symptoms

    Your individual risks will be discussed in detail prior to surgery based on your health history and imaging.

  • Most patients remain in the hospital for 1–3 days after TLIF. Early ambulation is encouraged, and many patients experience relief of leg pain soon after surgery. Back pain from the surgical site typically improves gradually. You may be prescribed a back brace, depending on surgeon preference. Activity restrictions include no bending, twisting, or lifting for several weeks. Driving and return to work are individualized based on the type of work and recovery progress. Follow-up imaging will monitor the progress of fusion, and physical therapy may be initiated to help restore strength and mobility.

 

Minimally Invasive Spine decompression

  • Minimally invasive lumbar decompression is recommended for patients with lumbar spinal stenosis, herniated discs, or ligament thickening that compresses the spinal nerves, causing symptoms such as back pain, leg pain (sciatica), numbness, or weakness. It is often performed when conservative treatments—like physical therapy, medications, or injections—fail to provide lasting relief.

  • This procedure is done through a small incision in the lower back using tubular retractors and a microscope. By gently dilating the surrounding muscles rather than cutting through them, the surgeon gains access to the spinal canal. Portions of bone (typically the lamina or facet) and/or ligament are carefully removed to relieve pressure on the nerves. In some cases, a small disc herniation may also be removed (microdiscectomy). Because the exposure is minimal, there is less disruption to normal tissue and a faster recovery compared to open surgery.

  • Although minimally invasive, the procedure still carries potential risks, including:

    • Nerve injury (numbness, weakness, or persistent pain)

    • Dural tear or spinal fluid leak

    • Infection

    • Bleeding or hematoma

    • Incomplete relief of symptoms

    • Need for further surgery (e.g., if instability develops later)

  • Patients often go home the same day or after an overnight stay. Most experience rapid improvement in leg symptoms, while back pain may take longer to improve. You’ll be encouraged to walk the same day and gradually increase activity. Most patients return to light activities within a week and normal activities over 4 to 6 weeks. Heavy lifting, bending, and twisting should be avoided during early healing. In some cases, physical therapy is recommended to restore mobility and core strength.

 

TOPS Surgery (Total Posterior Spine System)

  • TOPS surgery is designed for patients with lumbar spinal stenosis and low-grade degenerative spondylolisthesis (typically Grade I) who have leg pain, back pain, or neurogenic claudication that has not improved with non-surgical treatments. It is most often performed at the L4-L5 level, where stenosis and instability commonly occur. Patients must have motion at the affected level and no significant facet arthropathy or deformity at adjacent levels to be considered good candidates.

  • Through a posterior midline approach, the surgeon performs a standard laminectomy and bilateral facetectomy to decompress the spinal canal and nerve roots. Instead of fusing the spine, the TOPS implant is inserted to replace the removed posterior elements. The device is anchored with pedicle screws and is designed to preserve controlled motion in flexion, extension, lateral bending, and axial rotation, while blocking excessive motion that could cause instability.

    The goal is to relieve nerve compression and maintain spinal mobility, offering an alternative to traditional lumbar fusion.

  • As with any spinal implant surgery, there are potential risks, including:

    • Infection

    • Nerve injury or persistent nerve symptoms

    • Device loosening or mechanical failure

    • Wound healing complications

    • Adjacent segment degeneration over time

    • Need for revision surgery or conversion to fusion

    • Blood loss or dural tear

    Proper patient selection and surgical technique help reduce the likelihood of complications.

  • Patients typically stay in the hospital for 1–2 days. Most experience rapid relief of leg symptoms and can begin walking the same day or the next. Recovery is generally faster than traditional fusion, and patients may resume light activities within 2–4 weeks, with gradual return to full function. A brace may be used for comfort during early healing. Lifting, twisting, and bending are restricted during the initial recovery period, with physical therapy recommended to restore strength and stability.

    Follow-up imaging is performed to ensure the implant is stable and healing is progressing as expected.