Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C
Director, Quality & Patient Safety (QPS) – Och Spine Hospital
Medical Director, Spine Unit – Och Spine Hospital
Co-Chief of Spinal Deformity Surgery • NewYork-Presbyterian / Columbia University
Och Spine Hospital • New York, NY
Posterior lumbar fusion — most commonly performed as a transforaminal lumbar interbody fusion (TLIF) — is one of the most effective surgical treatments for lumbar conditions requiring stabilization, including spondylolisthesis, degenerative disc disease with instability, and lumbar stenosis with instability. Dr. Sardar performs instrumented lumbar fusion procedures using the Mazor X Stealth Edition robotic navigation system, ensuring precise pedicle screw placement.
WHAT IS POSTERIOR LUMBAR FUSION / TLIF?
Posterior lumbar fusion stabilizes one or more lumbar levels using pedicle screws and rods placed through the back of the spine. TLIF adds an interbody fusion — placement of a bone-filled cage inside the disc space from a transforaminal approach — which improves fusion rates, restores disc height, and achieves better correction than posterior instrumentation alone. The procedure accomplishes three goals simultaneously: decompression of nerve roots, stabilization of the unstable or painful segment, and interbody fusion promoting solid bone bridging across the treated level.
CONDITIONS TREATED
- Lumbar spondylolisthesis requiring stabilization and decompression
- Degenerative disc disease with instability or motion segment pain
- Lumbar stenosis with spondylolisthesis or instability
- Recurrent disc herniation after prior discectomy requiring fusion
- Adjacent segment disease after prior lumbar fusion
- Pseudarthrosis (failed prior fusion) requiring revision
- Adult degenerative scoliosis requiring limited or long-segment correction
ROBOTIC-ASSISTED NAVIGATION: WHY IT MATTERS
Pedicle screws must pass through the pedicle — a narrow bony bridge — with millimeter precision. Dr. Sardar uses the Mazor X Stealth Edition system for all instrumented lumbar procedures. Preoperative planning on the patient’s CT scan defines each screw trajectory before surgery. Intraoperative registration aligns the plan to actual patient anatomy using imaging. The robotic arm guides each screw along its pre-planned trajectory with precision the human hand alone cannot consistently achieve.
MINIMALLY INVASIVE VS. OPEN TLIF
For selected patients with focal disease at 1–2 levels without significant deformity, minimally invasive TLIF (MIS-TLIF) achieves the same fusion through smaller incisions with less muscle disruption, leading to less postoperative pain and faster recovery. Open TLIF is used for multilevel disease, deformity correction, and revision surgery where exposure requirements exceed what a minimally invasive approach can safely provide. Dr. Sardar performs both and selects based on what is genuinely appropriate for each patient.
RECOVERY
Hospital stay: 2–4 days for single-level; longer for multilevel cases. Return to light activity: 4–6 weeks. Return to sedentary work: 4–8 weeks. Return to physical work: 3–6 months. Fusion maturation: 12 months. Maximum functional gains are realized gradually over this period.
FREQUENTLY ASKED QUESTIONS
What’s the difference between fusion and TLIF?
TLIF is a specific type of posterior lumbar fusion that also places a cage in the disc space from the side, improving fusion rates and restoring disc height compared to posterior instrumentation alone.
Will I lose flexibility after fusion?
Motion is eliminated at the fused level, though most patients with single or two-level fusions don’t notice a significant functional limitation in daily activities.
Am I a candidate for minimally invasive TLIF?
This depends on whether your disease is focal (1 to 2 levels) without significant deformity. Multilevel disease or revision surgery often requires an open approach for adequate exposure.
Does robotic guidance make the surgery safer?
Robotic navigation supports precision in screw placement, but safety depends on many factors including surgical judgment and overall planning, not the technology alone.
How long until the fusion is fully solid?
Fusion maturation typically takes around 12 months, though most patients notice significant functional improvement well before that point.
WHY CHOOSE DR. SARDAR
Dr. Sardar uses robotic-assisted navigation as standard in all instrumented lumbar procedures — not as a differentiator, but because the evidence supports it as the standard of care for accurate, safe pedicle screw placement. He performs single-level minimally invasive TLIF through complex multilevel deformity reconstruction with equal technical proficiency, selecting the appropriate approach and technique for each patient.
This page is for educational purposes only and does not constitute individualized medical advice.
RELATED CONDITIONS & PROCEDURES
- Lumbar Stenosis & Neurogenic Claudication — the most common condition treated with lumbar fusion when instability is present
- Adult Lumbar Spondylolisthesis — vertebral slip requiring decompression and stabilization with TLIF
- Revision Spine Surgery — robotic navigation is particularly valuable in revision surgery with altered anatomy
- Robotic Spine Surgery — how the Mazor X Stealth Edition system works and what it means for patients
To schedule a consultation, call 212-932-5187 or visit the contact page.