Anterior Cervical Discectomy and Fusion
Recovery and Healing
How long will it take me to recover?
Most patients recover sufficiently to return to normal activities, including work and driving, within 2 to 3 weeks after anterior cervical discectomy and fusion (ACDF), provided there are no complications and the work is not physically demanding.
Pain and functional improvement are most pronounced within the first 3 months, with continued gains up to 6–12 months
When can I go back to work?
Most patients can return to work within 2–5 weeks after anterior cervical discectomy and fusion (ACDF), with a median time of 16 days for uncomplicated cases and those with sedentary or light-intensity occupations.
Patients in heavy-intensity occupations, older age, higher preoperative disability, or significant comorbidities (such as coronary artery disease or chronic obstructive pulmonary disease), return to work may be delayed, and heavy-intensity work is the strongest predictor of longer time to return.
Is it normal to still have neck stiffness or soreness?
It is common to experience some neck stiffness or soreness after anterior cervical discectomy and fusion (ACDF), but most patients report significant improvement in neck pain and function within the first 3–12 months after surgery
How long will I have to wear the cervical collar (if prescribed)?
We ask that you wear it for 2 weeks after your surgery. You may wear it longer for comfort.
Activity and Restrictions
When can I drive again?
This depends on multiple factors. Multiple levels may take longer to heal. You must be off all opioids and have a good range of motion.
When can I lift things?
Most patients can safely resume light lifting (such as household objects) within 2–3 weeks after anterior cervical discectomy and fusion (ACDF), as recovery kinetics demonstrate return to daily activities by 16 days for the majority of patients
When can I exercise or go back to the gym?
Most patients can safely resume light exercise and daily activities within 2–3 weeks after anterior cervical discectomy and fusion (ACDF), with early self-directed home exercise programs shown to be safe and beneficial for pain and function.
Return to more strenuous gym activities, such as weightlifting, high-impact aerobic exercise, or contact sports, should be delayed until there is clinical and radiographic evidence of solid fusion, typically at 3–6 months.
When can I bend, twist, or turn my neck normally again?
Most patients can expect to bend, twist, or turn their neck near their preoperative baseline by 6 to 12 months after anterior cervical discectomy and fusion (ACDF), with the majority of functional recovery and improvement in range of motion (ROM) occurring within the first 6 months
When can I travel by plane?
It is generally safe for most patients to travel by plane within 2 weeks after anterior cervical discectomy and fusion (ACDF), provided they are medically stable, have no unresolved pain, are not taking opioid medications, and have been cleared by their surgeon at the initial postoperative follow-up
Symptoms and Pain
Will my arm pain/tingling/numbness go away?
Most patients experience significant improvement or resolution of arm pain, tingling, and numbness after anterior cervical discectomy and fusion (ACDF), with benefits seen as early as 3 months and sustained at 1–2 years
Is it normal to have throat pain, hoarseness, or difficulty swallowing?
It is normal to experience throat pain, hoarseness, or difficulty swallowing (dysphagia) after anterior cervical discectomy and fusion (ACDF), with symptoms peaking in the first days to weeks postoperatively and typically improving over time. Dysphagia rates range from 45–87% at 2 weeks, with most cases being mild and transient; the incidence decreases to approximately 8–15% by 12–24 weeks, approaching preoperative baseline rates for most patients.
The majority of patients experience resolution of these symptoms within 3–6 months.
Why do my shoulders/shoulder blades hurt after surgery?
Postoperative muscular or soft-tissue pain from surgical retraction is common after ACDF and can cause pain in the shoulders or shoulder blades.
Incision and Wound Care
When can I shower?
After 48 hours.
What should I look for in case of infection?
Fever, increasing neck pain (especially new or worsening pain), redness, swelling, wound drainage, malaise, or chills should be monitored for as potential signs and symptoms of infection.
Do I need to change the dressing or will it dissolve/come off on its own?
We will remove the dressing at your first follow-up visit. If it falls off on its own that is ok. Keep the incision dry, pat dry, and avoid putting any ointments or creams on the site.
Long-Term Outcomes
Will the fusion limit my neck movement?
Anterior cervical discectomy and fusion (ACDF will limit neck movement after the procedure, specifically at the fused segment(s). The degree of limitation depends on the number of levels fused.
How long until the bone fully fuses?
Most patients achieve solid bony fusion between 6 and 12 months after ACDF, with confirmation by radiographic or CT criteria. Fusion rates and timing may vary based on the number of levels fused, implant material, and patient-specific factors.
Do I need physical therapy?
Physical therapy after ACDF is not routinely required for all patients.
What are the chances I’ll need another surgery in the future?
The chances of requiring another surgery after anterior cervical discectomy and fusion (ACDF are approximately 2–10% within the first 5 years, and up to 22% at 10 years.
Will I set off metal detectors or need a card for airport security?
It is possible to set off metal detectors after anterior cervical discectomy and fusion (ACDF), but this is not universal.
Anterior Lumbar Interbody Fusion
General Understanding
What exactly is an ALIF?
Anterior lumbar interbody fusion (ALIF) is a spinal fusion technique where the disc is accessed and replaced from the front (anterior) of the body, typically via a retroperitoneal approach. This contrasts with posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF), which access the disc from the back, and extreme lateral interbody fusion (XLIF/LLIF), which uses a lateral approach through the psoas muscle.
How long will the fusion take to heal?
Spinal fusion healing typically takes 6–12 months, with radiographic fusion rates exceeding 90% in most series. Complete bony fusion is the goal, but non-union rates remain 7–20% depending on patient factors.
Surgical Details & Hospital Stay
How long will I stay in the hospital?
Hospital stay averages 2–4 days, but minimally invasive ALIF may allow for shorter stays; same-day discharge is uncommon but possible in select cases
Will I have any drains or catheters after surgery?
Drains or catheters may be used postoperatively depending on intraoperative bleeding and surgeon preference.
ncision & Recovery
Where will my incision be?
The surgical incision is typically a transverse or oblique lower abdominal incision, which will leave a scar; minimally invasive techniques reduce scar size
What can I do after surgery — and what should I avoid?
Early ambulation is encouraged. Bending, lifting, and twisting should be avoided for 6–12 weeks to protect the fusion.
When can I return to work or daily activities?
Most patients resume light activities within 2–6 weeks; driving is allowed once narcotics are discontinued and mobility is sufficient.
Will I need physical therapy?
Physical therapy is commonly recommended after initial healing to restore function and strength
Post-Op Symptoms & Complications
Is it normal to have abdominal tightness, bloating, or bruising?
Abdominal tightness, bloating, or bruising are common and usually transient after ALIF.
Why do I feel numbness or tingling in my leg or groin?
Numbness or tingling in the leg or groin may result from nerve irritation or sympathetic plexus involvement, which is a known risk of the anterior approach
What are the risks of bowel, bladder, or sexual dysfunction?
Risks of bowel, bladder, or sexual dysfunction (including retrograde ejaculation in males) are present due to possible hypogastric plexus injury, especially at L5-S1.
When should I worry about fever, drainage, or pain?
Fever, drainage, or increasing pain may indicate infection or other complications and warrant prompt evaluation.
Medications & Pain Management
How long will I need to take pain medications?
Pain medications are typically needed for several days to weeks; duration varies.
Will I need a muscle relaxer or nerve medication too?
Muscle relaxers or nerve medications may be used for muscle spasm or neuropathic pain, but are not universally required.
Can I take NSAIDs after fusion surgery?
NSAIDs are often avoided in the early fusion period due to concerns about impaired bone healing.
Long-Term Outcome & Follow-Up
How will I know if the fusion is working?
Fusion success is determined by clinical improvement and radiographic evidence of bony bridging on X-ray or CT.
Will I need imaging to confirm healing?
Imaging is required to confirm healing; typically, you will have x-rays at your follow-up appointments.
Posterior Lumbar Interbody Fusion
- What is a posterior decompression and fusion?
Posterior decompression involves removing bone and soft tissue (e.g., lamina, ligamentum flavum, or facet joints) from the posterior aspect of the spine to relieve pressure on the spinal cord or nerve roots. Fusion is performed by joining two or more vertebrae using bone grafts and often instrumentation (screws, rods) to stabilize the spine and prevent abnormal motion.
- What is the difference between decompression, laminectomy, and fusion?
Decompression is a general term for surgeries that relieve pressure on the nerves in the spine. This pressure can cause pain, numbness, or weakness in the legs or back. Decompression can be done in several ways, depending on the cause of the pressure.
Laminectomy is a specific type of decompression surgery. In a laminectomy, the surgeon removes the lamina, which is a piece of bone at the back of the spine. Taking out the lamina creates more space for the nerves and helps relieve symptoms. Sometimes, only part of the lamina is removed (called a laminotomy), or just one side (called a hemilaminectomy).
Fusion is a different kind of surgery. In a fusion, two or more bones in the spine are joined together using bone grafts and sometimes metal hardware like screws or rods. The goal is to stop movement between those bones, which can help if the spine is unstable or if removing bone during decompression could make it unstable. Fusion is sometimes done at the same time as decompression, especially if there is a risk that the spine could become too loose after the decompression.
- Why do I need both decompression and fusion, not just one or the other?
If the spine is unstable, just doing decompression could make it even less stable, which might cause more pain or problems later. Fusion helps keep the spine steady after decompression.
Some people have a lot of movement between bones (shown on special X-rays), or the decompression surgery needs to remove a lot of bone. In these cases, fusion is more likely to be needed.
Studies show that for many people with mild or moderate spondylolisthesis, decompression alone works just as well as decompression with fusion, and recovery is often faster with fewer risks. But for people with clear instability, fusion may help prevent future problems.
Risks & Safety
- What are the main risks of this surgery?
- Nerve Injury
During surgery, nerves in the spine can be injured. This may cause numbness, tingling, weakness, or even loss of movement in the legs or feet. Most nerve problems get better over time, but some can be permanent.
- Dural Tear
The covering around the spinal cord (called the dura) can be torn during surgery. This can lead to headaches or fluid leaks. Most tears are repaired during surgery and heal well, but sometimes more treatment is needed.
- Infection
There is a risk of infection at the surgical site or deeper in the spine. Signs include redness, swelling, fever, or drainage. Infections may need antibiotics or another surgery to clean the area.
- Bleeding and Blood Transfusion
PLIF can cause more bleeding than some other spine surgeries. Sometimes a blood transfusion is needed.
- Hardware Problems
Screws, rods, or cages used in the surgery can move, break, or fail. This may require another surgery to fix or replace the hardware.
- Nonunion (Failed Fusion)
Sometimes the bones do not heal together as planned. This is called nonunion or pseudarthrosis. It can cause ongoing pain and may need another surgery.
- Adjacent Segment Degeneration
The bones and discs next to the fused area can wear out faster after surgery, sometimes causing new pain or nerve problems. This may happen months or years after surgery and sometimes needs more treatment.
- Blood Clots and Stroke
There is a small risk of blood clots in the legs (deep vein thrombosis) or lungs, and rarely, stroke. Moving soon after surgery and using special stockings can help lower this risk.
- Other Medical Complications
Heart, lung, or urinary problems can happen, especially in older adults or those with other health issues.
- Pain and Recovery
Some pain after surgery is normal, but sometimes pain lasts longer than expected. Recovery can take weeks to months, and physical therapy may be needed.
- Nerve Injury
- What are the chances of nerve injury?
Nerve injury after PLIF is uncommon, but it can happen. Most studies show that about 8–16 out of 100 people (8–16%) may have some nerve problems after surgery, such as numbness, tingling, or weakness in the legs or feet. Most of these problems are temporary and get better within weeks to months.
- What’s the risk of infection or hardware problems?
The chance of infection after PLIF is about 2–5 out of 100 people (2–5%). Sometimes, the bone does not heal properly around the hardware (called nonunion or pseudarthrosis), which can cause pain or need another surgery. Managing health conditions like diabetes and keeping a healthy weight can help lower risk.
Surgical Details
- Will screws and rods be placed, and how long do they last?
During a posterior lumbar interbody fusion (PLIF), screws and rods are almost always placed in the spine. These are called pedicle screws and rods, and they act like an internal brace to hold the bones steady while they heal together. The screws go into the back part of the spine (the pedicles), and the rods connect the screws to keep everything stable.
Screws and rods are designed to stay in the body permanently. They are made of strong materials like titanium or special medical steel, which do not rust or break down easily.
- How long does the surgery take?
This depends on how many levels are being fused. The patient’s health issues also must be factored in. The length of time for this surgery can vary, but most PLIF procedures take about 2 to 3 hours to complete in the operating room.
- How big will the incision be?
Traditional open PLIF: The incision is usually about 7 to 8 centimeters long (about 3 inches). This allows the surgeon to see and work on the spine directly. The exact size may vary based on the patient's body type and how many levels of the spine are being treated.
Recovery & Expectations
- How long will I stay in the hospital?
Most people who have posterior lumbar interbody fusion (PLIF) surgery stay in the hospital for about 2 to 4 days after their operation. This is the typical range for most patients who have an uncomplicated recovery and are able to get up and move around soon after surgery.
Some things can affect the hospital stay; these include: Age and overall health, any complications, and number of levels fused.
- When will I be able to get up and walk?
After surgery, you can walk from the PACU bed to your patient room bed. The earlier you ambulate, the quicker you recover and the fewer complications.
- How painful is the recovery?
Most people have moderate to severe pain in the lower back for the first few days after surgery. This pain is usually managed with medications and gets better as the body heals. Most patients feel the most pain in the first week after surgery. Pain usually improves steadily over the next few weeks and months. People with stronger back muscles and better mental health before surgery tend to have less pain after surgery. Patients who have more levels of the spine fused, more severe spondylolisthesis (slipped bones), or poor bone quality may have more pain after surgery.
- How long until I can go back to work or normal activities?
For office or desk jobs (sedentary work), many patients can go back to work as early as 6 weeks after surgery, especially if recovery is smooth and pain is well controlled.
For jobs that require lifting, bending, or heavy physical activity, it may take closer to 12 weeks or sometimes longer before it is safe to return.
Patients who were working before surgery, have fewer health problems, and participate in a structured rehabilitation program (like the REACT pathway) tend to return to work sooner.
Minimally invasive surgery may allow for a faster return to work and activities compared to traditional open surgery.
Following a rehabilitation plan that includes early movement, physical therapy, and support for returning to activity can help speed up recovery and improve confidence
- Will I need to wear a brace after surgery?
No, we do not have patients wear a brace after surgery.
- When can I drive again?
Studies using driving simulators show that reaction time is slower after lumbar fusion surgery, especially in the first few weeks. Most experts recommend waiting at least 6 weeks, and often up to 3 months, before driving again after PLIF.
- What activity restrictions will I have (bending, lifting, twisting)?
Lifting:
Avoid lifting anything heavier than 10 pounds (about the weight of a gallon of milk) for the first few weeks after surgery.
As healing continues, the allowed weight may increase, but heavy lifting should be avoided until cleared by the surgical team.
Bending and Twisting:
Avoid repeated or prolonged bending at the waist, especially in the first weeks after surgery.
Twisting motions (like turning the upper body while keeping the hips still) should also be limited early on, as these movements can put stress on the healing spine.
Gradual, gentle movement is encouraged, but any activity that causes more than a minor, temporary increase in pain should be avoided.
Sitting and Standing:
Change positions often. Do not sit or stand in one position for a long time.
Alternate between sitting, standing, and walking as needed for comfort.
Outcomes & Long-Term Outlook
- What are the chances my back/leg pain will improve?
Leg pain (pain that travels down the leg, also called sciatica) is usually improved or eliminated in about 70% to 85% of patients after PLIF, and this relief tends to last for years.
Back pain also improves for most patients, but the improvement is usually less dramatic than for leg pain. About 60% to 80% of patients report meaningful relief of back pain, but some may still have mild or moderate pain after surgery.
- Will I lose flexibility in my back after fusion?
For most people who have a one- or two-level fusion, studies show there is no serious limitation in most daily activities. Most patients can still bend, twist, and move enough for normal life, though some movements may feel stiffer than before surgery.[1]
If more levels are fused (three or more), especially if the fusion goes down to the pelvis, stiffness becomes more noticeable. Patients with long fusions may find it harder to bend over, twist, or get up from a chair, and may need to adjust how they do certain activities.
- How long do the implants last? Do they ever need to be removed?
These are intended to be permanent. Most people never need them to be removed. Removal is only needed if there is a complication, which is rare.
- Does fusion increase stress on the levels above and below?
PLIF is effective for stabilizing the lumbar spine but increases stress on the levels above and below the fusion.
This increased stress can accelerate degeneration at adjacent segments, sometimes leading to symptoms or the need for further surgery.
Practical / Lifestyle
- Will I set off airport metal detectors?
Having a PLIF does not guarantee that you will set off airport metal detectors, but it is possible, especially with full body scanners. The type of metal used in your implant and the number of levels fused do not make a significant difference. If you have concerns, consider carrying a medical card or letter from your surgeon when traveling.
Extreme Lateral Interbody Fusion
Understanding the Procedure
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What is an XLIF?
In XLIF, the surgeon reaches the spine from the side of the body, going through the muscles of the lower back but avoiding the major organs and blood vessels in the front and the nerves in the back.
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Why did you choose the lateral (side) approach for me?
XLIF is chosen because it is minimally invasive, often leads to less pain and faster recovery, and avoids the major blood vessels and organs in the front of the body. It is especially useful for certain levels of the spine (usually L1-L5), but is not typically used for the lowest level (L5-S1) because the pelvis blocks the way
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How long does it take for the fusion to heal?
Bone healing (fusion) usually takes 6–12 months. Most people start feeling better within weeks, but full fusion is confirmed by X-rays or CT scans over time.
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What levels of my spine were fused?
XLIF is most often used for the middle and upper lumbar spine (L1-L5).
Surgery & Hospital Stay
- How long will I be in the hospital?
Most patients stay in the hospital for 1–3 days after XLIF. Some may go home sooner if recovery is smooth.
- Will I have drains, tubes, or a catheter?”
Drains and catheters are not always needed. If used, they are usually removed within a day or two.
What position am I in during surgery?
During XLIF, you will be lying on your side. This allows the surgeon to reach your spine through a small incision on your flank.
- Is there a higher risk to nerves or blood vessels from the side approach?”
XLIF avoids major blood vessels and organs, but there is a risk of nerve irritation, especially to nerves that run through the psoas muscle. This can cause temporary numbness, tingling, or weakness in the thigh or groin. Most symptoms improve within weeks to months.
Incision & Recovery
- Where will the incision be?
The incision is made on the side of your lower back or flank. It is usually small and will leave a scar, but most patients find it heals well.
- Will I have numbness or tingling near the incision?”
Some patients experience numbness, tingling, or weakness in the thigh or groin after XLIF. These symptoms are usually temporary and improve over time.
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What activities should I avoid after surgery?”
After surgery, avoid bending, lifting, or twisting for several weeks. Walking is encouraged, but strenuous activity should be limited until cleared by your doctor.
- When can I go back to work or drive again?”
Most people return to light work and daily activities within 2–6 weeks. Driving is allowed once you are off pain medications and can move comfortably.
- Will I need physical therapy?”
Physical therapy is often recommended to help you regain strength and flexibility after surgery.
Post-Op Symptoms & Complications
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Is thigh or groin numbness/weakness normal after XLIF?
Common symptoms include soreness, mild swelling, and sometimes numbness or tingling in the thigh. Serious complications are rare but can include infection, blood clots, or nerve injury. Contact your doctor if you have fever, drainage from the incision, or severe pain.
- What is the risk of long-term nerve injury?”
The risk of long-term nerve injury associated with XLIF is low, but transient sensory and motor symptoms are common.
- What are warning signs I should call about?”
(Fever, drainage, increasing weakness, severe pain, new numbness, loss of bladder/bowel control.)
Pain & Medications
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How long will I need pain medication?”
Pain is usually managed with medications for a few days to weeks. Most patients need less pain medication than with traditional open surgery.
- Can I take ibuprofen or naproxen after fusion surgery?”
NSAIDs (like ibuprofen) are sometimes avoided in the first few months after fusion surgery because they may slow bone healing.
Imaging & Follow-Up
- Will I feel better right away?”
Most patients have less pain and better function after XLIF. The chance of needing another surgery is low, but not zero. If pain continues, further evaluation may be needed.
