Spinal Fusion
Minimally Invasive Spinal Fusion Surgery in Bergen County, New Jersey.
Spinal fusion is a surgical procedure that permanently joins two or more vertebrae together, eliminating motion at that segment of the spine. The goal is to stabilize a spinal level that is causing pain or neurological symptoms because of abnormal, painful movement, instability, or deformity, and to create a solid bony union that restores structural integrity to the affected area.
The concept behind fusion is straightforward. When a spinal segment degenerates to the point where the normal cushioning and load-bearing function of the disc is lost, or when a vertebra has slipped out of alignment or become structurally unstable, that segment can generate pain with every movement. Eliminating motion at that level through fusion removes the painful mechanical stimulus and, when combined with decompression of any compressed nerves, addresses both the structural and neurological aspects of the problem simultaneously.
Fusion is achieved using a combination of bone graft, which provides the biological material for new bone to grow between the vertebrae, and instrumentation in the form of screws, rods, and implants, which provide immediate mechanical stability while the fusion heals. Over a period of three to six months, the body generates new bone between the treated vertebrae, completing
the biological fusion process.
Rishi N. Sheth, MD performs all spinal fusion procedures using minimally invasive techniques at Spine Care New Jersey, with Mazor robotic assistance for instrumentation placement when appropriate. His certification in multiple specific fusion techniques including TLIF and DLIF,
along with his broader spine surgery fellowship training at the University of Miami, gives patients in Bergen County access to a comprehensive range of fusion options tailored precisely to their individual anatomy and condition.
Different Spinal Conditions Require Different Fusion Approaches.
Spinal fusion is not a single standardized operation. There are several distinct approaches to achieving a spinal fusion, each with its own access route, advantages, and ideal indications. Rishi N. Sheth, MD selects the approach most appropriate for each patient based on the specific condition being treated, the number of levels involved, the patient's prior surgical history, and their individual anatomy.
TLIF — Transforaminal Lumbar Interbody Fusion
TLIF is one of the most widely used minimally invasive lumbar fusion techniques. It is performed from a posterior approach, meaning from behind the patient. Through two small incisions on either side of the spine, pedicle screws are placed above and below the disc space using Mazor robotic guidance for precision. The disc is then removed through the foramen, and a structural implant filled with bone graft is placed into the disc space to support fusion. TLIF is effective for spondylolisthesis, degenerative disc disease, and stenosis with instability, and Dr. Sheth performs it routinely as a minimally invasive outpatient or short-stay procedure.
ALIF — Anterior Lumbar Interbody Fusion
ALIF accesses the lumbar disc space from the front of the body through a small abdominal incision, working in front of the major vessels to reach the disc. This approach allows for a larger implant to be placed in the disc space, which can achieve greater disc height restoration and a better lordotic angle than posterior approaches. ALIF is particularly useful for lower lumbar levels and is often combined with posterior instrumentation for maximum stability.
DLIF — Direct Lateral Interbody Fusion
DLIF, also called XLIF or lateral lumbar interbody fusion, accesses the lumbar disc space from the side of the body through a small incision in the flank. It avoids the major posterior muscles entirely and reaches the disc through a corridor between the abdominal wall and the psoas muscle. Because it involves no posterior muscle disruption, recovery is often faster than posterior approaches. Rishi N. Sheth, MD is specifically DLIF certified, and this approach is particularly valuable for patients with multi-level lumbar disc disease or deformity.
Posterior Lumbar Fusion
Posterior lumbar fusion involves placing pedicle screws and rods from behind without necessarily placing an interbody implant. It is used for decompression with stabilization, correction of spinal deformity, and cases where the disc space itself does not need to be reconstructed. Dr. Sheth performs posterior fusion using minimally invasive techniques with percutaneous screw placement to minimize muscle disruption.
Cervical Fusion
Cervical fusion is most commonly performed as part of an ACDF procedure, where the disc is removed from the front of the neck and the vertebrae are fused using a plate and bone graft. For patients with multi-level cervical myelopathy, posterior cervical fusion may be combined with laminectomy to decompress the spinal cord from behind and stabilize multiple levels simultaneously.
360 Degree Fusion
Some complex cases involving significant instability, deformity, or revision surgery require both anterior and posterior instrumentation to achieve adequate stability. Dr. Sheth discusses these more complex fusion approaches with appropriate patients and ensures that every patient understands the scope of the planned procedure before proceeding.
When Spinal Fusion Is the Right Surgical Choice.
Spinal fusion is a significant procedure with a meaningful recovery period, and Rishi N. Sheth, MD recommends it only when it is genuinely the most appropriate treatment for the patient's specific condition. Not every spine condition requires fusion, and not every patient who has been told they need fusion elsewhere actually requires it. Dr. Sheth reviews every patient's imaging, symptoms, and treatment history before making a fusion recommendation.
The conditions that most appropriately lead to a fusion recommendation include spondylolisthesis, where one vertebra has slipped forward over the one below it, creating instability that decompression alone would leave unaddressed. Degenerative disc disease at one or more levels where the structural failure of the disc is the primary driver of pain and the disc can no longer be preserved. Spinal stenosis combined with instability or deformity, where decompression without fusion would risk destabilizing the spine further. Recurrent disc herniation at a level that has already undergone microdiscectomy, where the remaining disc is insufficient to support the spine. Spinal deformity including scoliosis and kyphosis requiring correction and stabilization. And revision surgery after a previous fusion has failed or produced adjacent level disease requiring extension of the fusion.
In all cases, fusion is recommended only after appropriate non-surgical treatment has been genuinely tried. The only exception is when clinical urgency, such as rapidly progressive neurological deficit, makes early surgical intervention the clearly correct choice.
What Spinal Fusion Involves and What to Expect During Recovery.
The Procedure
Spinal fusion is performed under general anesthesia. The specific positioning depends on the approach being used. For TLIF and posterior lumbar fusion, patients are positioned face down. For ALIF and DLIF, a lateral or supine position is used. Rishi N. Sheth, MD uses Mazor robotic assistance for pedicle screw placement in instrumented fusion cases, providing computer-guided accuracy that significantly reduces the risk of screw malposition and its associated complications.
The procedure time varies considerably depending on the number of levels being fused, the specific approach, and whether decompression is being performed simultaneously. A single-level minimally invasive TLIF typically takes two to three hours. Multi-level or complex reconstructions may take longer. Dr. Sheth will discuss the expected operative time for the specific procedure planned during the preoperative consultation.
Hospital Stay
Most single-level minimally invasive fusions involve a hospital stay of one to two nights. Multi-level fusions or more complex reconstructions may require two to four nights depending on the extent of the surgery and the patient's medical status.
Recovery Timeline
The first two weeks focus on wound healing and gradually increasing walking tolerance. Most patients are walking with assistance the day after surgery and managing stairs and personal care within the first week. Pain medications are prescribed for the early postoperative period and tapered as recovery progresses.
Return to sedentary work typically occurs at four to six weeks for patients with physically undemanding jobs. More physically demanding occupations require eight to twelve weeks or longer depending on the requirements.
Physical therapy typically begins at four to six weeks and focuses on gradual core strengthening, walking endurance, and safe movement mechanics. Activities involving heavy lifting and impact are restricted until fusion is radiographically confirmed, which typically occurs between three and six months on follow-up imaging.
Lumbar fusion recovery, particularly for patients who have been living with significant leg pain and limited walking ability before surgery, often produces one of the most meaningful quality of life improvements available in spine care. Patients who could only walk one block before surgery frequently describe walking a mile or more comfortably by three months after a well-performed lumbar fusion.
Fusion Expertise Across Every Approach, in One Dedicated Practice.
Spinal fusion is one of the procedures where the full range of a surgeon's training and certification is most relevant. Different patient anatomies and conditions favor different fusion approaches, and a surgeon who is fluent in only one or two techniques is limited in what they can offer patients whose anatomy or pathology is better suited to an alternative approach.
Rishi N. Sheth, MD is trained and certified in the full range of lumbar fusion approaches, including TLIF, ALIF, DLIF, and posterior lumbar fusion, as well as cervical fusion techniques. His DLIF certification is a specific credential that relatively few spine surgeons in New Jersey hold, and it gives patients access to a lateral approach that often allows faster recovery than posterior techniques. His Mazor robotic certification ensures that instrumentation placement across all fusion types is performed with computer-guided precision that reduces hardware complications and revision rates.
Patients who have been evaluated elsewhere and told they need fusion are welcome to bring their imaging to Spine Care New Jersey for a second opinion. Dr. Sheth will review the case honestly and tell patients whether fusion is genuinely indicated, which specific approach is most appropriate for their anatomy, and what alternatives, including disc replacement for eligible patients, might be worth considering before committing to a fusion.
Common Questions About Spinal Fusion at Spine Care New Jersey.
Rishi N. Sheth, MD at Spine Care New Jersey in Bergen County is a board-certified spine neurosurgeon certified in TLIF, DLIF, and Mazor robotic fusion, fellowship-trained at the University of Miami and Memorial Sloan Kettering Cancer Center. He performs the full range of minimally invasive lumbar and cervical fusion procedures personally. New patients can book a consultation or request a free MRI review to determine whether spinal fusion is appropriate for their specific condition.
Most patients return to light activity within two weeks of a minimally invasive lumbar fusion. Return to desk work typically occurs at four to six weeks. More physically demanding work requires eight to twelve weeks. Physical therapy begins at four to six weeks and continues through the fusion healing period. Radiographic confirmation of solid fusion occurs at three to six months. The minimally invasive approach used by Rishi N. Sheth, MD significantly shortens recovery compared to traditional open fusion surgery.
Most PPO insurance plans cover spinal fusion when medically necessary and appropriately documented. Spine Care New Jersey is an out-of-network practice, meaning patients with PPO plans can use their out-of-network benefits to cover a meaningful portion of their care. Our team verifies your specific out-of-network benefits before your first visit so there are no surprises. Patients are encouraged to contact the office directly to discuss their specific insurance situation before scheduling.
TLIF, or transforaminal lumbar interbody fusion, approaches the disc space from behind through a posterior incision. DLIF, or direct lateral interbody fusion, accesses the disc from the side through a small flank incision, avoiding the posterior muscles entirely. DLIF often allows faster recovery due to less muscle disruption and can place a larger implant for better disc height restoration. Rishi N. Sheth, MD is certified in both techniques and selects the most appropriate approach based on each patient’s specific anatomy and condition.
Spine Care New Jersey in Bergen County offers the full range of minimally invasive spinal fusion procedures led by Rishi N. Sheth, MD, a Mazor robotic certified spine neurosurgeon certified in TLIF, ALIF, DLIF, and posterior lumbar fusion techniques. All fusion procedures are performed using minimally invasive approaches with robotic guidance for screw placement precision. New patients throughout Bergen County and northern New Jersey can book directly or request a free MRI review at spinecarenj.com.