OptiLIF Percutaneous Lateral Lumbar Fusion in Gainesville and Atlanta

Ultra-Minimally Invasive Lumbar Fusion

OptiLIF is one of the least invasive ways to fuse the lower spine. For the right patients, it can often correct the problem through incisions smaller than an inch, with a quick return home.

What Is OptiLIF?

OptiLIF is an ultra-minimally invasive lumbar interbody fusion procedure developed by Spineology. Like other fusions, it removes a damaged disc and fills the space with bone graft so the two vertebrae heal into one solid bone. What makes it different is how small the access is and the implant used.

Instead of a large, rigid spacer, OptiLIF uses the OptiMesh expandable implant, a soft, flexible mesh bag that is placed through a very small working portal. Once inside the disc space, it is filled with bone graft and expands to fit the shape of your disc space. This lets the surgeon create a large area for fusion through a tiny opening, with very little disturbance to the muscles, bone and nerves.

Illustration of an OptiLIF lumbar fusion with an interbody implant and percutaneous screws and rod

The disc is often reached through Kambin’s triangle, a small natural window on the side of the spine that avoids the main nerve and the spinal canal. Transforaminal approaches through Kambin’s triangle are one of Dr. Grunch’s signature techniques. The fusion is held steady with screws and rods placed through the skin.

Who Is a Candidate?

Degenerative disc disease or a collapsed disc causing back and leg pain
Low-grade spondylolisthesis or instability at one or two levels
Foraminal stenosis caused by a collapsed disc
Adjacent segment disease next to a previous fusion
Patients who want the smallest possible incisions and fastest recovery

OptiLIF isn’t right for every spine. Severe slips, significant deformity or extensive central stenosis may need a different fusion technique. Dr. Grunch will review your imaging and tell you which approach is best.

Treatments to Try First

Physical therapy: core strengthening and a structured exercise program
Medications: anti-inflammatory medications, muscle relaxers or nerve pain medications
Injections: epidural steroid injections or facet injections

When these no longer keep you active, surgery can often correct the problem.

How OptiLIF Is Done

Anesthesia and monitoring: You’ll be asleep, and nerve monitoring protects the nerves.
A tiny incision: Using live X-ray, a small working portal, usually less than an inch, is placed to reach the disc through Kambin’s triangle.
Clearing the disc: The damaged disc material is removed and the bone surfaces are prepared for fusion.
Placing OptiMesh: The folded mesh implant is passed into the disc space and filled with bone graft until it expands to fill the space and restore height.
Percutaneous screws: Screws and rods are placed through small incisions to hold the level steady while it fuses.
Closing: The small incisions are closed with dissolvable stitches and skin glue.

Watch how OptiLIF with the OptiMesh expandable implant works:

Video: OptiLIF with the OptiMesh Expandable Interbody Fusion System, courtesy of Spineology (YouTube)

Benefits and Risks

Benefits

Very small incisions and minimal muscle and bone disruption
A large area for bone to fuse, placed through a tiny opening
Less pain and blood loss
A short hospital stay and a faster return to activity

Risks

Infection or bleeding
The bones not fusing, which is more common in people who smoke
Irritation of the exiting nerve, causing temporary leg numbness or pain
Implant or screw problems that could require another surgery
Risks related to anesthesia

Why Choose Dr. Betsy Grunch for Your OptiLIF

Duke-trained: Dr. Grunch completed her neurosurgical residency and a spine research fellowship at Duke University School of Medicine, one of the top neurosurgery programs in the country, where she received the Spine Young Investigator Award.
Minimally invasive by design: Minimally invasive spine surgery, including transforaminal approaches through Kambin’s triangle, is one of her signature areas, so you can get back on your feet sooner.
Fusion only when you need it: She also performs lumbar and cervical disc replacement and decompression without fusion, so a fusion is recommended only when it’s truly the best option for you.
Experience you can count on: She has been in practice since 2013 and performs 400 to 600 surgeries a year, more than 5,000 procedures over her career.
Second opinions and revisions: She regularly sees patients who had spine surgery elsewhere and want a second opinion or need a revision.
A teacher at heart: As “Ladyspinedoc,” she is known for explaining spine conditions clearly. You’ll leave your visit understanding your imaging and every option in front of you.

What to Expect

Before surgery

You’ll meet with Dr. Grunch or one of her physician assistants to review your imaging, your exam and your goals, and to decide together whether OptiLIF is right for you. Our team will coordinate any pre-operative testing, review your medications (including blood thinners you may need to pause) and walk you through the day of surgery so nothing is a surprise. Smoking and nicotine slow bone healing and can cause a fusion to fail, so stopping before surgery is strongly recommended. Our office can help.

Procedure day

The surgery usually takes about two hours. Many patients go home the same day or after one night in the hospital, and they’re up and walking within hours of surgery.

Recovery timeline

First two weeks: Soreness at the small incisions is normal. Walk several times a day and wear your brace when you’re up.
Two to six weeks: Many people with desk jobs return to work. Your follow-up visit is at four to six weeks.
Six to twelve weeks: Restrictions are gradually lifted, and physical therapy may begin.
Six to twelve months: The bone graft continues to fuse.

Every patient heals differently. Your exact timeline will depend on your symptoms, the number of levels fused, your job and your overall health.

Caring for yourself at home

Back brace: Wear your brace whenever you’re out of bed and moving around.
Walking: Walk 30 to 60 minutes a day, broken into 10- to 15-minute sessions, and try not to sit for more than 30 minutes at a time.
Restrictions for about six weeks: No bending at the waist, no twisting and no lifting more than 10 pounds. That includes vacuuming, laundry, golf, yard work and lifting young children or grandchildren. Let others help you at home.
Your incision: If your incision is closed with skin glue, you may shower the day after surgery; if it has stitches or staples, wait three days. Don’t scrub, don’t use ointments or creams, and don’t soak in a bath, hot tub or pool for six weeks.
Medications: Avoid anti-inflammatory medications such as ibuprofen, naproxen, meloxicam, celecoxib and diclofenac, which can interfere with fusion. Blood thinners are held for 5 to 7 days after surgery until Dr. Grunch’s team tells you to restart them. Take pain medication with food, avoid alcohol while taking it, and use a daily stool softener.
Bone growth stimulator: If one is prescribed, the manufacturer will contact you after surgery.
Driving: You may drive once you are no longer taking narcotic pain medication, and you may ride as a passenger before then.
Follow-up: Your follow-up visit is about four to six weeks after surgery. Any outside stitches or staples are removed at 10 to 14 days.

Learn how a bone growth stimulator can support your fusion:

Video: Spinal Fusion Patients: Are You Using a Bone Growth Stimulator?, from Dr. Grunch on her Ladyspinedoc channel (YouTube)

Call the office at 470-293-9800 if you have a fever over 101°F, redness, warmth or significant drainage from the incision, calf pain or swelling, constipation that medication doesn’t relieve, new trouble controlling your bladder or bowels, or worsening pain down your leg. Call 911 for chest pain or shortness of breath.

Download your patient instructions

Print these sheets or save them to your phone so you have them before and after surgery:

You’ll find instructions for other procedures on our Patient Resources page.

Frequently Asked Questions

What is OptiMesh made of?

OptiMesh is a flexible, woven polymer mesh bag. It holds the bone graft in place inside the disc space while the bone heals and fuses.

How is OptiLIF different from a regular fusion?

The goal is the same, but OptiLIF reaches the disc through a much smaller opening and uses an expandable implant instead of a rigid spacer, so there is less disruption to your muscles and bone.

How small are the incisions?

The main working incision is usually less than an inch, plus small incisions for the screws.

Why can’t I take ibuprofen after surgery?

Anti-inflammatory medications can interfere with bone healing. Dr. Grunch’s team will tell you when it’s safe to restart them.

Am I a candidate?

The best way to find out is a consultation. Dr. Grunch will review your symptoms, exam and imaging to see whether OptiLIF or another approach is right for you.

Take the First Step Toward Relief

If you’ve been told you need a fusion, ask whether it can be done through the smallest possible incision. Whether you need a treatment plan, a second opinion or a clear explanation of your imaging, Dr. Grunch and the Southern Neurosurgery team are here to help.

Call 470-293-9800 to schedule an appointment or contact us online.

Have a question first? Ask our virtual assistant anything, 24/7.

We see patients across metro Atlanta and North Georgia at our offices in Gainesville, Sandy Springs and South Atlanta (Riverdale). Find the office nearest you.

This page is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. Please talk with your own doctor about your symptoms. If you have bladder or bowel changes, groin numbness or rapidly worsening weakness, call 911 or go to the nearest emergency room.