Getting Confused With The LIF’s: A Brief Explanation

Being diagnosed with a spinal condition where surgery may be the last resort can be overwhelming to any patient. Many patients find it hard keeping up with numerous medical terms. When it comes to understanding the different types of procedures available for a lumbar spine fusion, all the possibilities of surgeries ending with “LIF” can be frustrating. It is therefore important for patients to understand two basic principles before trying to understand the different procedures.

1. Lumbar spine fusion – the spine consists of 33 vertebrae: 7 cervical (neck), 12 thoracics (chest / upper back), 5 lumbar (lower back), 5 sacral (sacrum) and 4 coccygeal (tailbone). Fusion of the lumbar vertebrae can be necessary for patients with lower back pain to stabilize the spine, provide pain relief and increase function.
2. LIF – this stands for Lumbar Interbody Fusion. It means that all the various names of procedures ending with -LIF is a surgery where some of the lumbar vertebrae will be fused. Fusion can involve utilizing bone graft or implant. Fusion can be used to treat disorders such as spondylolisthesis, scoliosis, degenerative discs, or fractures.

Current techniques include PLIF, TLIF, MIS TLIF, XLIF, ALIF, OLIF, and OLLIF. Note that all the -LIF’s at the end mean the same thing – fusion of the lumbar spine. The letters that precede it represents the direction of the procedure where the spine is approached.

1. PLIF – stands for posterior LIF. This technique involves a traditional open approach directly from the back. A traditional open surgery means an incision is made to allow the surgeon direct access to the spine. The muscles are retracted and parts of the spine may be removed to allow access and room for the affected nerves. Implants are then inserted into the disc space to promote fusion.
2. TLIF – stands for transforaminal LIF. The spine is approached from the back but more from the side of the spinal canal after a midline incision is made on the patient’s back. The TLIF is less traumatic than the PLIF.

• MIS TLIF – stands for minimally invasive surgery (MIS) transforaminal TLIF. The only difference is that the procedure is performed using the minimally invasive technique where special instruments are used. Benefits of MIS include smaller incisions, less scarring, less blood loss, shorter hospital stays, less risk of infection, and faster recovery rates.

1. XLIF – stands for eXtreme lateral LIF. This MIS takes the side approach to the anterior spine, transversing the abdominal cavity to avoid disrupting the back muscles. Like other MIS, special equipment is used along with a fluoroscopy machine that guides the surgeon by providing real-time x-ray images.
2. ALIF – stands for anterior LIF. Similar to PLIF, the difference is the anterior approach to the spine through an incision in the abdomen or side. It may involve cutting through the muscles in the abdomen.
3. OLIF – stands for oblique LIF. It takes the front and side approach to the spine to achieve fusion.

References:

Distinguishing between the spinal OLIF and OLLIF procedures confusion with the war of the LIF’s. Inspired Spine. Accessed 6/23/2017.