My brother is going to have a spinal fusion alot like I did two years ago. The main difference is my surgery was done from the front. He says his surgeon is going to open him up from the back. Is this something new? How is it decided which way to do this operation?

Spinal fusion can be done in a variety of different ways. You may be describing the posterior interbody lumbar fusion (PLIF) and the anterior lumbar interbody fusion (ALIF). The basic surgery is the same between these two. The major difference is whether the surgeon opens the spine from the front (anterior) or from the backposterior.

The surgeon usually makes this choice based on several different factors. First is the patient’s symptoms. Neurologic symptoms such as numbness, tingling, or weakness may require the posterior approach. Back pain without signs of nerve damage can be treated with the ALIF.

The surgeon also develops his or her own preferences. Sometimes based on the surgeons own training, comfort, and types of patients treated, he or she may prefer one method over another.