Transforaminal Lumbar Interbody Fusion: What It Is and What to Expect
Medically reviewed by Sumiran Racherla, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor provides Transforaminal Lumbar Interbody Fusion?
A spine surgeon provides a transforaminal lumbar interbody fusion. A spine surgeon is a doctor who operates on the spine. Other treatments are tried first, and surgery is used when they do not help. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What it is
This surgery joins two or more bones in your lower back so they stop moving against each other. The bones are called vertebrae. A soft disc sits between them like a cushion. In this surgery, the surgeon removes the damaged disc and puts a cage filled with bone in the space where the disc was. Screws go into the vertebrae, and rods connect the screws to hold the bones steady while they heal together. It can be done as minimally invasive surgery through small cuts in the back.
Why a doctor might recommend it
Doctors recommend it for ongoing low back pain and nerve pain that has not improved with other care. It is used for spondylolisthesis, when one vertebra slips forward on another. It is also used for degenerative disc disease and for a disc herniation that has come back. Spinal stenosis, a narrowing of the canal around the nerves, is sometimes treated with fusion as well.
How to prepare
Common preparation steps include the following.
- Tell your surgeon about every medicine you take, even ones you bought without a prescription. Your surgeon may ask you to stop some pain pills and blood thinners before surgery. Follow your surgeon's or doctor's instructions about which medicines to stop.
- If you smoke, cut back or quit, since smoking slows healing.
- Prepare your home before surgery.
- Tell your surgeon about any illness, since surgery may be postponed.
- Follow your surgeon's or doctor's instructions about eating and drinking before surgery.
What happens during it
You will receive general anesthesia, which puts you into a deep sleep. You lie on your stomach. The surgeon works from the back through two small cuts. Screws are placed into the vertebrae, and rods connect the screws. The damaged disc is removed, and a cage filled with bone is put in the space where the disc was. The bone may come from your own pelvic bone, from a bone bank, or from an artificial substitute. The surgery can take 3 to 4 hours.
Recovery
You may stay in the hospital for up to 3 to 4 days. You will get medicine for pain. The team will teach you how to log-roll out of bed, which means moving your whole body at once without twisting the spine. You will learn to sit, stand, and walk safely. You may need to wear a back brace at home.
Risks and side effects
All surgery has risks. These include reactions to anesthesia, bleeding, blood clots, and infection. Nerve damage can cause weakness, pain, numbness, or problems with your bowels or bladder. Spinal fluid leakage may need more surgery. The bones above and below the fusion can wear away faster over time. In some people the bones do not heal together fully. Surgery does not always improve pain and can make it worse in some cases. Call 911 if you have chest pain, trouble breathing, bleeding that will not stop, sudden weakness in your legs, or a sudden loss of bladder or bowel control. Contact your surgeon if you have a fever of 101F (38.3C) or higher, drainage from the wound, calf pain, or new loss of feeling in your legs or feet.
Who performs it
A spine surgeon performs this surgery, using small cuts and special tools.
Common questions
Where does the bone graft come from?
The bone may come from your own pelvic bone, from a bone bank, or from an artificial bone substitute.
Why are screws and rods used?
Screws go into the vertebrae, and rods connect the screws. Together they hold the vertebrae still so the bone graft can heal and join them together. The hardware keeps the spine steady while the fusion grows.
Will all of my back pain go away?
No. Surgery does not always improve pain, and it is unlikely to take away all of your pain. It is hard to predict how much relief you will get. Losing weight and getting exercise increase your chances of feeling better.
How does a direct primary care or concierge doctor fit in?
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. They can manage conditions like diabetes and heart disease before surgery.
Sources
- MedlinePlus - Spinal fusion
- American Association of Neurological Surgeons - Minimally Invasive Spine Surgery
- MedlinePlus - Spine surgery - discharge
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
