Dr. Erick Kazarian, MD
NYU Langone Spine Surgery — Patient Information
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Lumbar Fusion (PLIF/TLIF)
Lumbar Fusion Surgery (Posterior Lumbar Interbody Fusion)
Lumbar fusion surgery is a procedure designed to permanently join two or more vertebrae in the lower back, eliminating painful motion between them and restoring spinal stability. This surgery is most commonly recommended for patients with degenerative disc disease, spondylolisthesis (a condition in which one vertebra slips forward over another), spinal stenosis, recurrent disc herniations, or instability caused by fractures or deformity. When conservative treatments such as physical therapy, medications, and injections have not provided adequate relief, lumbar fusion may offer a path toward lasting improvement.
During a posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF), Dr. Kazarian accesses the spine from an incision in the lower back. The damaged disc material is carefully removed from between the affected vertebrae, and a spacer (called an interbody cage) filled with bone graft material is placed in the disc space to restore proper height and alignment. Screws and rods are then secured to the vertebrae above and below to hold everything in position while the bone graft gradually fuses the vertebrae into a single, solid segment. Over time, new bone grows through and around the graft, creating a permanent biological bond.
The goal of lumbar fusion is to reduce pain, improve stability, and help you return to a more active and comfortable daily life. While recovery from spinal fusion takes longer than many other procedures, the majority of patients experience meaningful relief from their back and leg symptoms and are able to resume activities they had been unable to enjoy. Our surgical team is committed to guiding you through every phase of your care, from your initial consultation through your full recovery.
Images & Diagrams
Pre-Operative Instructions
Careful preparation before your lumbar fusion surgery helps ensure the safest possible procedure and supports a smooth recovery. Please follow these instructions closely and contact our office with any questions.
Review all current medications and supplements with Dr. Kazarian.
2 weeks before surgeryStop blood thinners (warfarin, aspirin, Plavix), NSAIDs (ibuprofen, naproxen), and herbal supplements (fish oil, vitamin E, ginkgo) as directed. If you take diabetes medications, you will receive separate dosing instructions. GLP-1 receptor agonists (Ozempic, Wegovy, Mounjaro, Trulicity, Saxenda) must be stopped 7 days before surgery due to the risk of aspiration under anesthesia. Do not stop any medication without Dr. Kazarian's approval.
Obtain medical clearance from your primary care physician and any relevant specialists.
2-4 weeks before surgeryThis may include blood work, an EKG, and a health review. Bring clearance letters and your CPAP machine (if applicable) on surgery day.
Do not eat or drink anything after midnight the night before surgery.
After midnight the night before surgeryThis includes water, coffee, gum, and mints. You may take approved medications with a small sip of water.
The NYU perioperative team will call you the day before surgery with your arrival time.
Day of surgeryLocation: NYU Langone Kimmel Pavilion, 424 East 34th Street, Manhattan. Bring a valid photo ID, insurance card, and medication list.
Arrange for a responsible adult to drive you home and stay with you for several days.
Arrange before surgery dayYou cannot drive after general anesthesia. Expect a 1-3 day hospital stay. Have someone available at home for at least 1-2 weeks, as bending and lifting will be restricted.
What to Expect on Surgery Day
Knowing what will happen before, during, and after your lumbar fusion can help ease any anxiety and allow you to focus on your recovery. Here is a step-by-step overview of your surgical experience.
Check-In and Pre-Surgical Preparation
You will arrive at the hospital approximately two hours before your scheduled surgery. Our nursing team will verify your identity, review your medical history and current medications, and place an intravenous (IV) line. You will change into a hospital gown, and the surgical site on your lower back will be confirmed and marked. Dr. Kazarian and anesthesiologist will visit you to review the procedure, answer any remaining questions, and ensure you feel comfortable and informed before heading to the operating room.
Anesthesia Administration
Lumbar fusion is performed under general anesthesia, which means you will be completely asleep and will not feel anything during the operation. Once in the operating room, the anesthesia team will administer medication through your IV and place a breathing tube to support your airway. Specialized monitors will track your heart rate, blood pressure, oxygen levels, and in many cases your spinal nerve function throughout the entire procedure to ensure your safety.
The Surgical Procedure
You will be carefully positioned face-down on a specialized surgical table. Dr. Kazarian will make an incision along the midline of your lower back over the affected vertebrae. The muscles are gently moved aside to expose the spine. The damaged disc is removed, any bone spurs or tissue compressing the nerves are cleared, and an interbody cage packed with bone graft is placed into the disc space. Titanium screws are inserted into the vertebrae above and below, and connecting rods are secured to stabilize the segment. The procedure typically takes two to four hours depending on the number of levels being fused and the complexity of your condition.
Wound Closure and Dressing
Once the instrumentation is in place and Dr. Kazarian has confirmed proper alignment with intraoperative imaging, the surgical site is thoroughly irrigated and the incision is closed in multiple layers using dissolvable sutures beneath the skin and either sutures or surgical staples on the surface. A sterile dressing is applied over the incision. A small drain may be placed near the surgical site to prevent fluid accumulation during the first day or two of recovery.
Recovery Room and Hospital Stay
After surgery, you will be taken to the post-anesthesia recovery area where nurses will closely monitor your vital signs, pain level, and neurological function in your legs and feet. You will likely feel groggy as the anesthesia wears off. Pain medication will be provided to keep you comfortable. You will then be moved to your private room, where your care team will continue to monitor your recovery. Most patients are encouraged to stand and take a few supervised steps with assistance within the first 24 hours, as early mobilization promotes healing. A physical therapist will work with you on safe movement techniques during your hospital stay. Most patients are discharged one to three days after surgery.
Risks & Potential Complications
All surgical procedures carry some degree of risk. Dr. Kazarian takes every precaution to minimize these risks, and serious complications are uncommon. Understanding the potential risks helps you make an informed decision and know what to watch for during your recovery.
Infection
There is a small risk of infection at the surgical site or deeper around the spine. Antibiotics are given before and after surgery to reduce this risk. Signs of infection include increasing redness, swelling, warmth, or drainage from the incision, as well as fever.
Blood Loss
Some blood loss is expected during spinal fusion surgery. In rare cases, significant blood loss may occur that requires a blood transfusion. Your surgical team monitors blood loss closely throughout the procedure.
Cerebrospinal Fluid Leak
The protective membrane (dura) surrounding the spinal cord and nerves may occasionally be opened during surgery, allowing spinal fluid to leak. If this occurs, it is typically repaired during the procedure. In rare cases, additional treatment may be needed after surgery.
Adjacent Segment Disease
After fusion, the spinal segments above and below the fused area may experience increased stress over time. This can lead to degeneration at those neighboring levels, potentially causing new symptoms months or years after surgery. Not everyone who has a fusion develops this condition.
Neurologic Injury
There is a small risk of injury to the spinal nerves during surgery, which could result in new or worsened numbness, tingling, weakness, or pain in the legs. In very rare cases, more significant nerve injury may occur. Dr. Kazarian uses specialized techniques and monitoring to minimize this risk.
Hardware Failure
The screws, rods, or other implants used to stabilize the spine can occasionally loosen, shift, or break before the fusion has fully healed. If this happens, additional surgery may be needed to replace or adjust the hardware.
Nonunion (Pseudarthrosis)
In some cases, the bone may not fully fuse as expected, a condition called nonunion or pseudarthrosis. This can cause persistent or recurring pain and instability. Factors such as smoking, diabetes, and poor nutrition can increase this risk. If nonunion occurs, a revision surgery may be recommended.
Need for Additional Surgeries
While lumbar fusion is often successful, there is a possibility that additional surgeries may be needed in the future. This could be due to nonunion, hardware issues, adjacent segment disease, or other factors. Dr. Kazarian will discuss your individual risk factors with you.
Recovery
Recovery from lumbar fusion is a gradual process that unfolds over several months. While many patients notice significant improvement in leg pain and overall comfort within the first few weeks, the bone graft requires approximately six to twelve months to fully mature into solid fusion. Patience, adherence to your activity restrictions, and commitment to your rehabilitation program are the keys to a successful outcome. Your surgical team will monitor your progress at each follow-up visit and adjust your activity level as healing advances.
Prescribed Medications
| Medication | Type | Dosage | Frequency | When to Take |
|---|---|---|---|---|
| Flexeril (cyclobenzaprine) | Muscle Relaxer | 5 mg | Every 6 hours as needed | Take for moderate to severe muscle spasm or pain |
| Tylenol (acetaminophen) | Pain Reliever | 500–1000 mg | Every 6 hours as needed | Take for mild pain |
| Oxycodone | Opiate Pain Reliever | 5–10 mg | Every 4–6 hours as needed | Take for moderate to severe pain not controlled by Tylenol or NSAIDs |
Always take medications exactly as prescribed by your surgeon. Do not combine pain medications without consulting your doctor.
Immediate Post-Operative Phase
The first two weeks are focused on managing pain, protecting the surgical site, and beginning gentle mobilization. You will be up and walking short distances with assistance before leaving the hospital and should continue walking at home several times a day. Pain and soreness around the incision are expected and will be managed with prescribed medications. You may notice that leg pain from nerve compression has already improved, even while the incision area is still tender. A physical therapist may visit you in the hospital to teach safe techniques for getting in and out of bed, sitting, and walking.
- No bending at the waist, twisting the torso, or lifting anything heavier than five pounds
- Do not drive or operate machinery while taking narcotic pain medications
- Avoid prolonged sitting for more than 20 to 30 minutes at a time
- Do not soak the incision in water — no baths, swimming pools, or hot tubs
- Walk short distances several times daily as tolerated, gradually increasing distance
Early Recovery Phase
During this period, your pain should steadily decrease and your endurance for walking will improve. You may begin transitioning from prescription pain medication to over-the-counter options such as acetaminophen as directed by Dr. Kazarian. Light daily activities such as preparing simple meals and personal hygiene tasks become more manageable. Dr. Kazarian may recommend wearing a lumbar brace during this phase to provide additional support and remind you to limit bending and twisting. Formal physical therapy often begins during this period with a focus on core stabilization, gentle stretching, and posture awareness.
- Continue to avoid bending, twisting, and lifting more than ten pounds
- Wear your lumbar brace as directed by Dr. Kazarian
- No strenuous household chores such as vacuuming, mopping, or yard work
- Avoid sitting for longer than 30 to 45 minutes without standing and walking briefly
- Do not begin any exercise program without clearance from Dr. Kazarian
Progressive Activity Phase
As your fusion site continues to heal, you will gradually increase your activity level under the guidance of Dr. Kazarian and physical therapist. Physical therapy will progress to include core strengthening exercises, flexibility work, and functional training for daily tasks. Many patients are cleared to begin driving during this phase and may return to light or sedentary work. Walking distance and pace should increase steadily. Dr. Kazarian will order imaging to assess the early progress of fusion and determine when restrictions can be eased.
- Lifting is typically limited to 15 to 20 pounds until cleared for more
- Avoid high-impact activities such as running, jumping, or contact sports
- Do not lift heavy objects from the floor — use proper body mechanics at all times
- Continue attending physical therapy sessions as prescribed
- Report any new or worsening back or leg pain to Dr. Kazarian
Fusion Maturation and Full Recovery
By six months, many patients have experienced substantial improvement and are returning to most of their normal activities. However, the bone graft continues to strengthen and mature for up to twelve months or longer. Dr. Kazarian will use X-rays or CT imaging to evaluate the solidity of the fusion. As confirmed fusion progresses, activity restrictions are gradually lifted. Advanced strengthening, return to recreational sports, and resumption of physically demanding work are typically addressed during this phase. Some patients continue to experience incremental improvement in comfort and function throughout the first year.
- Follow Dr. Kazarian's specific guidance on returning to heavy lifting and strenuous sports
- Maintain a regular exercise routine to support long-term spinal health
- Practice good body mechanics to protect your spine, especially at adjacent levels
- Attend all scheduled follow-up appointments to monitor fusion progress
Follow-Up Schedule
- 2 weeks after surgery: Incision check, wound healing assessment, and review of early recovery progress
- 6 weeks after surgery: Clinical evaluation of pain and neurological function, possible X-rays, discussion of return to driving and light work
- 3 months after surgery: X-rays to assess fusion progress, physical therapy progress review, and gradual return to more activities
- 6 to 12 months after surgery: Follow-up imaging to confirm solid fusion and final assessment of outcomes
When to Call Your Doctor
Contact our office immediately if you experience any of the following:
- Fever above 101.5 degrees Fahrenheit or worsening chills, which may indicate an infection at the surgical site or elsewhere
- Increasing redness, swelling, warmth, or drainage from the incision, especially if the drainage becomes cloudy, discolored, or foul-smelling
- Sudden onset of severe back pain or new leg pain, numbness, or weakness that was not present immediately after surgery
- Difficulty with bladder or bowel function, including inability to urinate, loss of bladder control, or new bowel incontinence, which requires urgent evaluation
- Chest pain, sudden shortness of breath, or significant swelling and tenderness in your calf or leg, which may indicate a blood clot and requires immediate medical attention
- Pain that is progressively worsening rather than gradually improving, or pain that is no longer controlled by your prescribed medications
- Any signs of wound separation, such as the incision edges pulling apart or an area of the incision that appears to be opening
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