Lower back · Lumbar spine
Posterior Spinal Fusion PSF
Posterior spinal fusion stabilizes the spine from the back: pressure on the nerves is relieved, and bone graft, usually held by screws and rods, lets the vertebrae heal together as one.
Kornelis Poelstra, MD, PhD performs PSF for patients in Lakeland, FL and across Central Florida, including the Tampa Bay and Orlando areas.
Understanding the problem
Why posterior spinal fusion may be needed
Normal spine
The lower (lumbar) spine consists of the bony vertebrae, discs, nerves and other structures. The vertebrae stack up to create the spinal column and protect the spinal cord and nerve roots. The end of the spinal cord (conus) is near the top of the lumbar spine. Below this, the nerve roots hang down in individual strands that together look somewhat like a horse's tail, so they are called the cauda equina. The nerve roots travel out through small bony windows (foramina). The discs between each vertebra have a fibrous outer layer (annulus) around a gel-like center (nucleus); they allow motion, act as shock absorbers and distribute stress on the spine.
Stenosis, degeneration and spondylolisthesis
Various conditions, from developmental problems and disease to trauma or the normal aging process, can lead to pain, deformity or difficulty with daily activities. The most common is arthritis of the spinal joints, which can narrow the room around the nerve roots (spinal stenosis) through bone spurs, cysts or other degenerative changes. Another is slippage of one vertebra on the one below it, called spondylolisthesis.
As we age, the water and protein content of the discs and cartilage changes, making them thinner and more fragile. The gradual wear of the discs is called degenerative disc disease, and it shows on X-ray or MRI as a narrowing of the disc space. Degeneration can narrow the spinal canal (stenosis) and press on the nerve roots, which can cause pain that radiates down the thigh or leg with walking or standing (neurogenic claudication). If the pressure continues, numbness or weakness in the leg or foot may develop.
Spondylolisthesis is when one vertebra slips forward over the one below it. It may result from trauma, degenerative changes or a developmental crack in the vertebra. In some people the slippage presses on the nerve roots, causing back and/or leg pain, typically with walking or standing.
Most patients with stenosis have mild findings and do not have serious symptoms. Some people may need surgery if the nerve roots are severely irritated or the spine becomes unstable. Rarely, urgent surgery is needed for cauda equina syndrome or progressive weakness. Symptoms of cauda equina syndrome may include changes in bowel or bladder function, numbness or change in sensation around the buttocks, genitals or inner thighs, and weakness or radiating numbness in the legs. Anyone who develops these symptoms should seek medical attention immediately.
The surgery
How posterior spinal fusion is performed
Posterior spinal fusion (PSF) is an operation to stabilize the spine, relieve pressure on irritated nerves and help keep that pressure from returning. The surgery uses an incision in the middle of the back.
Through an incision in the middle of the back, the surgeon protects the nerve roots and removes the bone spurs, cysts or other material pressing on the nerves. Bone graft is then placed along the back of the spine, allowing the vertebrae to grow together as one (fusion) over the months after surgery. Screws and rods are often placed to hold the bones while the fusion heals.
Unlike an interbody fusion, the disc itself is usually left in place; the fusion forms along the back and sides of the spine.
The goal of this surgery is to stabilize the spine and relieve leg or back pain, numbness, weakness, or loss of coordination caused by pressure on the nerves. The surgery typically lasts two hours or more, depending on the number of levels treated, any previous surgery and the severity of pressure on the nerves. With one or two levels, blood loss is usually minimal. Most patients go home three to five days after surgery.
After the operation the area needs to be kept relatively still so the fusion can heal. This may mean activity restrictions, a soft support brace or a rigid plastic brace, as your surgeon advises.
If the disc space also needs support, a spacer can be added through the same incision (PLIF or TLIF) or from the front (ALIF).
Already have an MRI? Find out if you may be a candidate with a video review from Dr. Poelstra.
Risks
Risks of posterior spinal fusion
Surgery and anesthesia involve stresses to many organs and tissues in the body. Incisions and handling tissues during surgery can result in problems. The benefits of surgery must be carefully weighed against these risks. Some of the more common or serious problems are listed here.
Nerve root injury
Permanent nerve root injury is extremely rare. It is not unusual, however, to experience minor temporary tingling, numbness, weakness or pain which resolves over several weeks. All precautions are taken, but rarely more serious nerve root injuries may occur, affecting walking, balance, or bowel or bladder function.
Failure of fusion
On rare occasions the bone graft does not heal properly. The likelihood of this is greatly increased by smoking or using nicotine of any kind. This can cause the hardware to fail and the graft to shift, and additional surgery may be needed. We recommend quitting smoking at least one month before surgery and not smoking for at least 3 months after. Smoking also speeds degeneration of the spine and increases the chance of needing treatment at another level.
Dural tear
Leakage of spinal fluid can occur due to a tear in the tissue (the dura) that holds the spinal fluid and surrounds the nerves. On rare occasions additional surgery may be needed.
Infection
Infection is always a post-operative risk and occurs in approximately 1–2% of surgical patients, varying by surgery type. Infections may be superficial or deep into the bone. You are given antibiotics before and after surgery to help prevent this. Please follow the wound care instructions to help prevent infection.
Other complications
Other possible complications include blood clots, pneumonia and complications related to general anesthesia.
Recovery
Posterior spinal fusion recovery timeline
- Hospital
Most patients go home three to five days after surgery.
- First visit
Wound check and stitch removal if needed. Walking about 15 minutes twice a day.
- 2–3 weeks
Incision pain usually improving. No driving until cleared, typically about 3 weeks.
- About 6 weeks
Walking 30–40 minutes twice a day, as directed.
Activities and exercise
Rehabilitation is an important part of recovery. Many patients have had spinal pain for some time, which can weaken the spinal muscles, so return to your normal activities slowly.
The main form of rehabilitation after surgery is a walking program. Start after discharge and walk a little more each day, generally two to three times per day. Many patients are walking about 15 minutes twice a day by their first post-operative visit, and 30–40 minutes twice a day by about six weeks after surgery, as directed by your surgeon.
Expectations
Many patients notice a reduction in back and leg pain after surgery; of the two, leg pain is usually more predictably relieved. If the nerve has been irritated for a long time, improvement may be more gradual. As the nerve heals, tingling or a warm feeling is common. Strength often improves next. Numbness in the leg or foot is usually the last to improve and, if present for a long time before surgery, may not fully resolve. Every patient's recovery is different.
Back pain from the incision usually improves within two to three weeks. Increased pain with prolonged sitting and driving is also expected, and for safety we recommend not driving for approximately three weeks, or until your surgeon clears you.
Aftercare
Caring for yourself at home after spinal fusion
Wound care
- At your first post-operative visit we will inspect your wound and remove any stitches as needed.
- Do not soak your wound: no bathtub, swimming or hot tub until your surgeon says it is OK. Do not remove any butterfly strips next to your skin; they are designed to get wet and fall off in the shower over time.
- If you have a clear plastic bandage over your wound, you may shower right away. You may remove the clear plastic once home, then shower as described below.
- If you have a gauze dressing instead, do not shower until 72 hours after surgery, and only if the bandage has no wet drainage on it.
- To shower: remove the outer gauze bandage and shower as usual. Blot the incision dry, then cover it with a clean, dry bandage.
Medications
Prescribed narcotic pain medication may cause constipation. Increase your fluid and fiber intake (fruits, vegetables, whole grains) and walk as much as possible.
If you need a refill, please have your pharmacy send the refill request to our office and allow up to 48 hours for it to be processed. Refills are not filled after hours, on weekends or on holidays, so keep track of how much medication you have and request refills before you run out.
Activity limitations
Avoid heavy lifting, repetitive bending and twisting of your back until your surgeon tells you it is safe. Walking is encouraged. Do not drive until your surgeon has cleared you.
Questions
Posterior spinal fusion: frequently asked questions
What is a posterior spinal fusion?
It is a fusion done from the back of the spine. After freeing the nerves, the surgeon places bone graft along the back of the spine so the vertebrae heal together, usually held by screws and rods while the fusion heals.
What is the difference between PSF and PLIF?
In a PSF the fusion forms along the back and sides of the spine and the disc is usually left in place. In a PLIF the disc is also removed and replaced with spacers through the same incision.
How long is the hospital stay after posterior spinal fusion?
Most patients go home three to five days after surgery. Your surgeon will decide when it is safe for you to go home.
Will I need a brace?
The fused area needs to be kept relatively still while it heals. This may mean activity limits, a soft brace or a rigid brace, as your surgeon advises.
Does smoking affect spinal fusion?
Yes. Smoking or using nicotine of any kind greatly increases the chance that the fusion does not heal. We recommend stopping at least one month before surgery and not smoking for at least three months after.
Do I need fusion surgery for lumbar stenosis?
Not always. If the spine is stable, decompression alone may relieve nerve pain in the buttock and legs. Fusion is considered when there is significant instability.
Your surgeon
Kornelis Poelstra, MD, PhD
Orthopedic & Neurological Spine Surgeon
- Board Certified, American Board of Orthopaedic Surgery
- PhD in Biomedical Engineering, University of Groningen
- Orthopaedic residency, University of Virginia
- Spine fellowship, Rothman Institute, Thomas Jefferson University
PSF may be considered for
Every patient is different. This page is general information, not medical advice, and is not a promise of any particular result. Whether surgery is right for you, and which procedure, can only be decided after an in-person evaluation with a surgeon. All surgery carries risks, which Dr. Poelstra will review with you. Illustrations are for general education only.
Wondering if PSF is right for you?
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Patient stories
What our patients are saying
In their own words, from patients treated by Dr. Poelstra. Rated 4.5 on Google from 43 reviews.
Talk about having confidence in my surgeon and the PA! I did not even meet my specialists until right before my surgery! I had read about Dr. Poelstra online and had every bit of confidence in him. It is not very often you meet a doctor who is very knowledgeable, explains what he is going to do and what he had to do, but he was truly concerned about me.
Outstanding doctor!!!! Went to my first visit and wow he was absolutely awesome. He thoroughly explained to me everything about my case and I knew the first time when I left his office I was very confident he was the right surgeon.
Just had a complex cervical spine surgery performed by Dr. Poelstra. My osteoporosis certainly made the surgery more of a challenge. Dr. Poelstra devoted a lot of time and attention to my particular problems before coming up with a solution. Am also thrilled to report not only did the surgery go well, but I have experienced zero pain and am still pain free, 3 weeks post-surgery.
Most amazing doctor. We travelled from New Mexico for my husband’s back surgery. We believed in his evaluation, but his skill and compassion excelled. Dr Polestra did an extensive surgery and the outcome was much better than we had dared to hope.
I did extensive research prior to my ACDF surgery and consulted with 3 other surgeons. Those 3 felt like a transaction. Then I was referred to Dr. Poelstra by a different Doctor.
From my consultation to my post-op appointments, Dr. Poelstra provided world class care. Dr. Poelstra is gifted and his immense expertise and meticulous attention to details is evident. Dr. Poelstra is incredibly kind and genuine. He greets with a warm smile at each appointment, taking the time to truly listen and ensure I felt comfortable.
It is rare to find a surgeon who pairs such high-level brilliance with such a sincere human touch.
I HIGHLY recommend him to anyone who is seeking the best possible care.
For about 3 years I have had a complicated life due to pain in my back and hands, loss of balance, and falls. I visited orthopedists and neurologists, but they did not give me a solution that convinced me. I met Dr. Poelstra, and he knew how to give me a good solution. Finally, I had my surgery, and I can assure you that since then my pain has disappeared, my balance has returned, and I have regained some strength in my hands. Thank you, Dr. Poelstra, for helping me recover my quality of life.
I went to see Dr Poelstra for a second opinion because I had severe neck pain with numbness and pain radiating across my shoulder, down my left arm with constant headaches for over 6 months. Dr. Poelstra reviewed my MRI suggested ACDF surgery, Anterior Cervical Discectomy and Fusion surgery. He stated that I had 2 ruptured discs, C5-C6 and C6-C7 and the discs were pushing my spinal cord to the back and right. I am now 3 weeks post surgery and feel terrific! I woke up from surgery with ZERO pain. I was absolutely surprised that I had no pain.
Dr. Poelstra has an amazing bed side manner and did an excellent job! I’m so happy and relieved that my pain is gone.
I was initially scheduled to have my surgery though another doctor, but after my 2nd visit I was told I was be seeing Dr. Polestra and he left the exam room for abou 10-Minutes. In that time I Googled Dr. Polestra and was floored by his excellent reviews. His experience in robotic surgery is unmatched. He has done robotic spine surgeries than anyone on the planet, period (It's a fact) Anyway, I had been dealing with a bad back, more specifically L3-S1 from an injury sustained in 1985, yes, 1985. Finally in 2024 It was done. It got too bad to bear, the pain was too much. I was super anxious as he told me it would be two surgeries. 1 entering through the belly and two days later through the back. Two surgeries had me second guessing the whole thing. The morning of the surgery as I laid there waiting to be wheeled in Dr. Polestra came by to talk to me. He was excellent at making me feel better about the surgeries. He explained it all again and why he chose (chooses) to do double surgery in these cases. I felt way better and he made sure of that before walking away. Dr Polestra has a very calming and uniquely cool personality. I am a bit of a personality and he stood toe to toe. Haha. The 1st and 2nd surgeries were a complete success. (Dec 11th & 13th 2024) I was up walking around after both surgeries. i was honestly worried about pain levels post-surgery. I shouldn't have been. Post Op pain was incredibly low considering. Dr. Polestra and his PA saw me 2 times in the 4 days in the hopital. Each time ensured any questions I had were answered. He made certain to let me know where he expected me to be and where I was each time. I liked that a lot.
15 Month Post Op update 3/17/2026: No back pain since surgery. Mobility is great and no issues. I feel like a truly lucky person having had Dr. Polestra for my surgeries. So many years of pain and my back going out to no pain and my back not going out. Feeling today as if I won the back surgery lotto. If you have Dr. Polestra consider yourself luckily and stick with him. Brilliant
I recently had my spine surgery with Dr. Poelstra. He did a phenomenal job. I feel so much better. He was very caring through the whole process. I would recommend him to anyone looking for spinal surgery.
I came to his office after 13 years of not being able to sit or stand up, straight or very long. Within a few months and 2 surgeries, I am better than ever and absolutely 💯 no pain and 95% movement. About 5 disc replacements and 2 rods in my back. I had to learn how to walk and sit upright again. I have and will always recommend this man and his assistant. When I talked and explained......they LISTENED. Thank you for your attention and miracles!!
I am beyond happy with this surgeon. After he gave me a spinal fusion from L5-S1, I have strength back in my legs, the pinching of my nerves are gone, I don't feel the knife/stabbing pain in my back and bottom area anymore. He treats his patients so nicely, with dignity and respect. Amazing bedside manor. He advocates for his patients and makes sure you're well taken care of. If I ever need anything in the future, I will be coming back to this doctor. He truly is amazing. I can't recommend him enough.
I came to Dr. Poelstra after going to pain management for over 2 years for him to discover that the bone of my hips had completely deteriorated and I had something called a vascular necrosis. He is absolutely amazing, and a lifesaver. Thank you Dr. Poelstra, because of you I can walk again!
After two years of consistent lower back pain, injections and RFA, I needed a second opinion.
From my first visit, I felt like his family. He took the time to explain his findings, offered conservative suggestions, but ultimately together we decided a single level fusion would offer me the best chance at becoming “mostly” pain free.
I was so impressed by Dr. Poelstra that I read any literature I could find about his surgical approaches and listened to pod casts detailing the latest in medical techniques and equipment.
I am now 3 weeks post operative and I feel better than I have in the last few years! I can stand straight, bend over, twist and simply do things I haven’t been able to do in some time. I am so thankful to have found someone who cares about his profession and his patients so much.
I had the unfortunate need for spinal fusion repair and we found Dr. Poelstra and his team. Rather than viewing my “mess” as a problem he saw it as an opportunity to give me my quality of life back. I had been suffering with chronic back pain for the past six years due to six spinal fusions and their failure to give me the desired result.
Dr Poelstra did an AMAZING job. He did a complete hardware revision which we didn’t think was possible. He is a highly skilled surgeon with the latest robotics technology. He is not only a top surgeon but also a caring and kind humanitarian.
I’m already on the road to recovery after just days with less pain and standing straighter than ever!
Thank you Dr. Poelstra! Highly recommend you!
Dr. Poelstra just did my L-4/5 and rebuilt my L-5/S1. What an amazing surgeon!!!
I feel like a new man, mobility and range of motion is better than ever. Plus his positive energy is very infectious.
A truly gifted surgeon and all around great person!!! 5 Stars forever ⭐️⭐️⭐️⭐️⭐️!!!
No one wants to undergo spinal back surgery, but Dr. Poelstra is an excellent surgeon with an incredible team. I felt very comfortable with his confidence and reassurance regarding my surgery.
A true lifesaver! His knowledge and precision are amazing! My husband had six spinal fusions. He was in so much pain and all they did was give him pain meds and say we can’t do anymore surgeries. Dr. Poelstra was on duty and after looking at his xrays was confident he could fix his problems. There was fluid on his back and broken rods and loose screws. Dr. Poelstra was able to remove almost all of the old hardware and replace it with new. Immediately the pre surgery pain was gone. They are so kind and genuine. And today, less than two weeks later he has minimal post surgery pain. Standing tall and not hunched over. Highly recommend him. I wouldn’t go anywhere else!
Dr Poelstra and his team are the most amazing Surgeons you will ever come across, they with out a doubt saved my husbands life, he had one of the most difficult spine issues that other Dr’s would not touch. Dr Poelstra had a plan executed and it worked beautifully.
Spine surgeon extraordinaire! Ensures that he does exactly what is needed, no more, no less. Lays out the facts, the options, and then lets you decide on how to proceed. No surgeon can foresee the end result, but his confidence and especially his bedside manner put you at ease in making the correct surgical decision.
My husband and I highly recommend Dr. Poelstra. We both had to have back surgery, one year apart. Dr. Poelstra is a brilliant surgeon who utilizes the most high tech cutting edge modalities available, individualized for each case. When I was told he would using robotics during my surgery I was scared and reluctant but the results are amazing. The screw placement is so precise, it looks fake on the x-ray. But here I am, strong and flexible. My husband is a veteran who was wounded severely but the spine issues were never addressed successfully. I took him to Dr. Poelstra who miraculously corrected the issues that plagued him for so long. Dr. Poelstra had to modify certain things due to my husband's abdominal wounds and scar tissue but my husband now stands up straight again and is OUT OF PAIN. He doesn't walk weirdly anymore and feels like a new man. We are so grateful for his expertise, care and humanity.
I am a patient of Dr. Kornelis Poelstra, who performed surgery on my lower lumbar. If you haven't already done so, I suggest first looking up his CV to understand the extent and depth of his experience and education. It's also worth noting that Dr. Poelstra holds a PhD in addition to being a MD which is not the norm. An in-person meeting will demonstrate Dr. Poelstra's expertise and yes, kindness. I thought I had lost my previous life four years ago when my back decided to stop working. Dr. Poelstra just gave it back. Further, his robotics has minimized recovery time. It's an invasive surgery but I'm only two weeks in and already I'm walking around, feeling pretty darn good. I plan on hitting the ski slopes in the near future - imagine that!
With three previous cervical fusions, my upper neck and head bent almost 30° forward. After reviewing my MRIs and x-rays, Dr. Poelstra looked at the overall issue and through surgery was able to pull my head and cervical spine back at least 20° and recenter my head over my shoulders. The surgery was a great success, and I no longer have the stress and strain on my mid and lower back. I feel great, and I am able to look up and forward instead of at the ground. Great job Dr Poelstra! 👍🏻
I have had 2 previous surgeries and needed a doctor with the expertise to help stop my shoulder and arm pain. Dr Poelstra found a more severe issue and talked to me about it and we decided surgery was needed. Dr Poelstra did an amazing job. He worked around my previous surgeries and completely fixed the problem. He is very informative and makes sure you understand and helps you make the decision. Would definitely go to him again. His staff is very professional and caring.
Unbelievable. Efficient, proficient, and effective. He carefully explained the condition of my spine and offered a conservative solution. The first surgeon to offer an explanation of the underlying cause. He did a disc replacement in the morning and I went home the same day. No pain! Slight sore throat for 48 hours until swelling went down a bit. A great experience. Great surgeon and support staff.
Thanks to this wonderful surgeon, I have my husband back. My husband started falling and was unable to control his balance. That is where we met Dr. K. Poelstra, ordering a MRI of Neck/Spine and there it was. As they talked surgery, both my husband and I cringed. But Dr. Poelstra was so knowledgeable and experienced about the ACDF (Anterior cervical discectomy and fusion) procedure. Next day it got done. The next day my husband was up walking, steady on his feet, wanting to go home. I won't lie he had to wear a collar around his neck and no driving for 2 weeks and he had a little sore throat but it was a small price to pay for getting your active life back. I can't say enough about Dr. Poelstra and his amazing staff. Very professional, caring and knowledgeable, three great qualities when dealing with the spine.
I prolonged having surgery for way too long and suffered throughout that time. Dr. Poelstra was still able to increase my quality of life 100 percent. Amazing surgeon and a wonderful person! Thank you
I’ve been fighting terrible back pain for 5 years, plus things were rapidly going for the worse, not to mention I’ve had injections, nerve blocks, pain management, and on and on. I visited 3 doctors total and out of the 3 Dr Poelstra was by far the most knowledgeable, caring, understanding my whole situation. He explained with models of a spine, he showed me exactly what he was going to do right to the end of my surgery. He did an A-LIF and a P-LIF lumbar spine, which is front and back, two surgeries two days apart. I’m 7 weeks post op and my pain level is from above a 10 all day and all night to a 2-5 level and not even being 100% healed I feel like a new person. I can honestly say this man gave me a second chance at my life. I highly recommend Dr Poelstra, this man is honest. It feels good to walk with a smile.
My husband had the robotic back surgery from Doctor Poelstra. He is very knowledgeable in his field of work and very kind. He called me 2xs during the surgery to let me know how everything was going. He and his staff are A+. Highly recommendable!
Dr. P gave me my life back! Before my surgery I couldn't stand or walk for more than 5 minutes. 10 weeks out of surgery and I can stand and walk endlessly. Surgical sore at times, but I will take that over pre-surgery pain any day of the week!
I found him to be very professional, caring and knowledgeable. He showed great concern and was very sympathetic to my situation, after 3 failed surgeries from a previous doctor, I am walking better than before.
My experience with Dr. Poelstra was very pleasant. He knows his craft very well and was very informative. I highly recommend him. Plus he has a nice personality. The surgery seems to have gone well.