anterior abdominal incision Posterior lumbar interbody fusion (PLIF) – the disc is accessed from a posterior incision Transforaminal lumbar interbody fusion (TLIF) – the disc is accessed from a posterior incision on one side of the spine Transpsoas interbody fusion (DLIF or XLIF) – the disc is accessed from an incision through the psoas muscle on one side of the spine Oblique lateral lumbar interbody fusion (OLLIF) – the disc is accessed from an incision through the psoas muscle obliquely Risks Spinal fusion is a high risk surgery and complications can be serious, including death. In general, there is a higher risk of complications in older people with elevated body mass index (BMI), other medical problems, poor nutrition and nerve symptoms (numbness, weakness, bowel/bladder issues) before surgery. Complications also depend on the type/extent of spinal fusion surgery performed. There are three main time periods where complications typically occur: During surgery Patient positioning on operating table Blood loss Damage to nerves and surrounding structures during procedure Insertion of spinal hardware Harvesting of bone graft (if autograft is used) Within a few days Moderate to severe postoperative pain Wound infections - risk factors include old age, obesity, diabetes, smoking, prior surgery Deep vein thrombosis (DVT) Pulmonary embolism (PE) Urinary retention Malnutrition Neurologic deficit Weeks to years following surgery Infection – sources of bacterial bioburden that infiltrate the wound site are several, but the latest research highlights repeated reprocessing of implants before surgery and exposure of implants (such as pedicle screws) to bacterial contaminants in the "sterile-field" during surgery as major risk factors. Deformity – loss of height, alignment, and failure of fusion Pseudarthrosis – nonunion between fused bone segments. Risk factors include tobacco use, nonsteroidal anti-inflammatory drug use, osteoporosis, revision procedures, decreased immune system. Adjacent segment disease – degeneration of vertebrae above/below the fused segments due altered biomechanical stresses or patient propensity to develop progressive degenerative change. Epidural fibrosis – scarring of the tissue that surrounds the spinal cord Arachnoiditis – inflammation of the thin membrane surrounding the spinal cord, usually caused by infection or contrast dye. Recovery Recovery following spinal fusion is extremely variable, depending on individual surgeon's preference and the type of procedure performed. The average length of hospital stay for spinal fusions is 3.7 days. Some patients can go home the same day if they undergo a simple cervical spinal fusion at an outpatient surgery center. Minimally invasive surgeries