Watch Dr. Sarraj explain
After your surgery
Your postoperative protocol
Dr. Sarraj’s instructions for activity, medicines, wound care and follow-up. Your hospital discharge instructions and individual care plan take priority.
Lumbar fusion
The shared protocol for ALIF, LLIF and posterior lumbar fusion.
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What the operation involves
LLIF reaches the lower spine through an incision in your side. The affected disc is removed and a cage containing bone graft is placed between the vertebrae. This restores space and supports the bones while they grow together. Screws may also be placed through incisions in the back.
The direct lateral approach, also called XLIF or DLIF, passes through the psoas muscle. This muscle helps lift your thigh towards your body. A related approach called OLIF passes in front of the psoas; its muscle effects and risks differ. Your surgeon will explain the approach planned for you.
Why this approach may be chosen
Restoring disc height can create more room for nerves without removing tissue directly around them. This is called indirect decompression. Some patients also need a separate decompression through the back. The choice depends on the narrowing, alignment, stability and levels being treated.
Fusion from the side is one option. Fusion from the front or back, decompression alone or nonsurgical treatment may be alternatives, depending on your condition.
Thigh symptoms and hip-flexion weakness
After a direct lateral approach, temporary soreness in the groin or front of the thigh, tingling or numbness, and weakness lifting the leg on the approach side can occur. Getting that leg into bed or a car, or climbing stairs, may initially be harder. These effects can come from irritation of the psoas muscle or nearby nerves.
Tell the hospital team about weakness before going home so they can check your strength and walking. Early weakness that has been assessed and discussed with you often improves gradually, although recovery may take weeks to months. Persistent symptoms need review.
New or worsening weakness after discharge, knee buckling, a new foot drop or difficulty walking safely needs urgent assessment. Do not assume it is simply the expected muscle effect of LLIF.
Walking and daily activities
Start short, frequent walks as soon as it is safe, including on the day of surgery when possible. Use the walking aid or assistance recommended in hospital if your leg feels weak. Have help on stairs until you can manage them safely.
Keep walking regularly during the first six weeks and increase distance gradually. LLIF uses the same lumbar fusion postoperative protocol as ALIF and posterior lumbar fusion. Download it above for lifting limits, bending and twisting precautions, physiotherapy, medicines, wound care and follow-up.
Temporary nerve irritation can cause tingling, shooting pains or “zingers,” or a flare of leg pain. These may settle with healing, but new or worsening weakness and the other warning signs below need assessment.
Risks to discuss
Risks include infection, bleeding, blood clots, nerve injury, implant problems and failure of the bones to fuse. The side approach can irritate or injure the psoas muscle and the nerves that supply the leg; weakness or altered sensation can sometimes persist. Nearby bowel or blood vessels can also be injured. Additional surgery may be needed if the nerves remain compressed or another problem develops.
When to seek urgent help
- Go to an emergency department for new or worsening leg weakness, knee buckling, new foot drop, inability to walk safely, numbness around the groin, new difficulty passing urine or loss of bladder or bowel control.
- Seek urgent assessment for new or increasing abdominal pain, increasing abdominal swelling, repeated vomiting, or inability to pass gas with pain or swelling.
- Seek urgent assessment for new one-sided leg swelling or calf pain. Call 911 for sudden breathlessness, chest pain or collapse.
- Contact the surgical team promptly for fever, increasing wound redness or drainage, or pain not controlled by your discharge plan. If you cannot reach the team, seek urgent medical assessment.
Questions for your appointment
- What is the main goal of this treatment for me?
- Which symptoms are likely to improve, and which may remain?
- What are the alternatives and the risks of waiting?
- What help will I need at home, and when can I return to my usual activities?
Educational information to support your consultation. The options, risks, and recovery described here may differ from your individual plan. Contact your treating team about new or changing symptoms.