Lumbar Spine Surgery · Naples & Fort Myers, FL
Lumbar Fusion —
when it’s right,
done right.
Fusion is not the enemy. When the anatomy calls for it, a well-planned, precisely executed lumbar fusion can restore stability, eliminate pain, and give you your life back. The approach matters. The alignment planning matters. The technology matters. Dr. Katsevman brings all three.
"Fusion done well can be life-changing. Patients still golf, play pickleball, touch their toes, and go back to the gym. The goal is getting you back to living — not just fixing an MRI."
Dr. G. Katsevman, MD · Fellowship-Trained, Barrow Neurological InstituteDr. K selects the right one
before every fusion
on every fusion case
available for select cases
to optimize fusion healing
When fusion is the right answer
Not every patient needs fusion.
Some genuinely do.
Dr. Katsevman performs lumbar fusion — and recommends it when it is genuinely the most appropriate surgical choice. He also offers disc replacement, TOPS, and minimally invasive laminectomy as alternatives when the anatomy allows. The right surgery depends on the right diagnosis.
High-Grade Spondylolisthesis
Grade II or higher spondylolisthesis — significant vertebral slippage with mechanical instability that cannot be managed with decompression alone. Fusion restores and locks the alignment, eliminating the instability driving the pain.
Severe Degenerative Instability
Disc degeneration combined with abnormal motion on flexion-extension X-rays. When the spine is genuinely unstable — not just painful — fusion provides the structural correction that decompression alone cannot.
Lumbar Scoliosis & Deformity
Adult degenerative scoliosis causing leg pain, imbalance, and progressive deformity. Multi-level fusion corrects and stabilizes the curvature, decompresses the nerves, and restores upright posture and balance.
Revision Surgery
Adjacent segment disease after prior fusion, hardware failure, or pseudarthrosis (failed fusion). Extension of existing constructs or correction of prior surgery requires the stability and permanence that only fusion can provide.
Severe Facet Arthritis with Instability
When the facet joints are destroyed by arthritis to the point that they can no longer stabilize the motion segment, decompression alone risks worsening the instability. Fusion stabilizes the segment while relieving the nerve compression.
DDD Not Amenable to Disc Replacement
Degenerative disc disease with anatomy or factors not suited to disc replacement — such as severe facet disease, significant deformity, osteoporosis, prior instrumentation, or other contraindications. Fusion with meticulous alignment planning provides durable, lasting relief.
The five approaches
The approach is chosen for your anatomy
There is no single “lumbar fusion surgery.” There are five distinct surgical approaches to place the interbody spacer — each with specific advantages, limitations, and ideal indications. Dr. Katsevman selects the approach that gives each patient the best mechanical result for their specific anatomy, levels, and goals.
ALIF — Largest cage, no muscle disruption
Access is through the front of the abdomen (retroperitoneal), assisted by a vascular surgeon who moves the major abdominal vessels aside to expose the front of the lumbar spine. This approach allows placement of the largest possible interbody cage — maximizing disc height restoration, foraminal decompression, and fusion surface area.
Because the approach is anterior, the posterior back muscles are never touched. This means less post-operative muscle pain, faster recovery, and no disruption to the posterior stabilizing structures. If pedicle screws are needed for additional stability, they can be placed through a separate small posterior incision with minimal muscle dissection.
Best for: L4-5 and L5-S1 — the most common fusion levels. Excellent for restoring lordosis (the natural lumbar curve) and correcting sagittal alignment.
LLIF / XLIF / PTP — Lateral fusion, single-position option
Access is from the side of the abdomen through the flank, passing through the retroperitoneal space and psoas muscle to reach the lateral aspect of the disc. Like ALIF, this approach spares the posterior back muscles entirely — but it can also access multiple lumbar levels in a single position without repositioning the patient, making it ideal for multi-level fusions.
LLIF places a wide, large footprint interbody device that provides excellent indirect decompression of the foramen by restoring disc height. It is highly effective for correcting scoliosis and sagittal deformity across multiple levels.
Important limitation: LLIF cannot reach L5-S1, where the iliac crest obstructs lateral access. For L5-S1, ALIF or a posterior approach is required. Dr. Katsevman frequently combines LLIF for upper levels with ALIF at L5-S1 in multi-level cases.
Dr. Katsevman also performs PTP (Prone Transpsoas) — the same lateral interbody surgery performed with the patient in the prone (face-down) position rather than the standard lateral decubitus (on their side) position. Because the patient is already prone, pedicle screws can be placed in the same position without repositioning — shortening operative time and reducing anesthesia exposure. The prone position also naturally increases lumbar lordosis, improving sagittal alignment restoration compared to the lateral position. PTP provides all the benefits of LLIF with the added efficiency of single-position surgery.
TLIF — The workhorse posterior approach
TLIF is performed from the posterior (back), approaching the disc through the foramen on one side. Pedicle screws and rods are placed in the same surgery. It is the most versatile posterior approach — usable at any lumbar level, allowing direct decompression of the nerve roots, and not requiring repositioning or an anterior surgical team.
The interbody cage placed through a TLIF approach is smaller than in ALIF or LLIF because the working corridor between the traversing nerve root and the exiting root limits the size of the implant. However, the simultaneous decompression and ability to work at any level make TLIF the most commonly performed posterior interbody fusion approach in the world.
Dr. Katsevman performs TLIF with robotics and navigation for every pedicle screw placed, and uses EOS EDGE alignment planning pre-operatively to ensure the implant sizing and rod contouring restore the correct lordosis for each patient’s anatomy.
PLIF — Direct posterior access when anatomy demands it
PLIF is performed from directly behind the spine, placing two smaller interbody cages on either side of the dura through bilateral nerve root retraction. It provides excellent direct visualization of the canal and both nerve roots, and allows bilateral decompression in the same approach.
Because both sides of the canal are accessed, PLIF requires more bone removal and slightly more nerve retraction than TLIF. It remains a valuable approach for specific anatomic situations where bilateral access is advantageous, and Dr. Katsevman selects it when it is the most appropriate tool for the anatomy.
Precision technology
How fusion is planned and executed at this practice
The decision to fuse is only half the equation. How the fusion is planned, how the alignment is optimized, and how precisely the hardware is placed determine whether the result is good — or great.
EOS EDGE Full-Body Alignment Planning
Before any lumbar fusion, Dr. Katsevman uses EOS EDGE — a full-body, weight-bearing X-ray system that captures the entire spine from head to pelvis in a single image with dramatically less radiation than traditional imaging. Specialized software then measures critical alignment parameters: lumbar lordosis, pelvic incidence, sacral slope, and global sagittal balance.
These measurements guide the selection of interbody cage lordotic angle, implant size, and rod contouring before the patient ever enters the operating room. Not all fusion surgeons plan alignment this carefully — and the difference shows in long-term outcomes.
Robotics & Navigation
Every pedicle screw placed by Dr. Katsevman uses real-time spinal robotics and navigation. This is not a marketing feature — it measurably improves screw accuracy, reduces radiation exposure to the patient and surgical team, and lowers the risk of misplaced hardware causing nerve injury.
Studies consistently show robotics and navigation reduces screw misplacement rates compared to freehand technique. In minimally invasive fusion cases, where the visual landmarks are limited, navigation is essential to safe, reproducible hardware placement. Dr. Katsevman uses it on every fusion.
BMAC — Bone Marrow Aspirate Concentrate
At the time of fusion surgery, Dr. Katsevman offers Bone Marrow Aspirate Concentrate (BMAC) — a biologic augmentation derived from the patient’s own bone marrow, rich in mesenchymal stem cells, growth factors, and osteoprogenitor cells that directly support bone formation and fusion healing.
BMAC is applied to the interbody cage and posterolateral graft site, giving the fusion the biological stimulus it needs to achieve solid, durable bone bridging. It is particularly valuable in smokers, diabetics, patients on steroids, and those with prior failed fusions — populations where fusion healing is inherently more challenging. BMAC is derived from your own body; no rejection risk.
BMAC is an optional patient-elected augmentation and is not covered by insurance. It is one of the distinguishing elements of Dr. Katsevman’s fusion practice.
Minimally Invasive Approach as the Default
When the anatomy allows, Dr. Katsevman performs fusion through minimally invasive percutaneous or tubular approaches — placing pedicle screws through small skin stabs with real-time navigation, rather than the long midline incisions and extensive muscle stripping used in open fusion surgery.
The result is less blood loss, less post-operative muscle pain, faster mobilization, and shorter hospital stay — without compromising the mechanical quality of the fusion construct. Most minimally invasive fusion patients are discharged in 1–2 days rather than 3–5.
aprevo® — Patient-Specific 3D-Printed Implants
In select cases, Dr. Katsevman uses the aprevo® Personalized Spinal Fusion Implant — a custom-made interbody cage 3D-printed from high-strength titanium, designed from a CT scan of your specific spine. No two aprevo implants are alike because no two spines are alike.
Traditional stock implants come in standard shapes and sizes that may not match a patient’s unique vertebral contours or lordotic angle. Studies show 62% of adult spinal deformity patients remain malaligned after surgery with stock implants. aprevo eliminates that mismatch — the implant is engineered to your anatomy before you ever enter the operating room.
The aprevo process: your CT scan generates a precise 3D model of your spine → Dr. Katsevman approves the custom implant design → the implant is 3D-printed in titanium and delivered to the hospital. The result is a cage that fits your exact spinal contours, restores the correct alignment for your anatomy, and maximizes the fusion surface area for durable long-term healing.
aprevo is particularly valuable in complex deformity cases, revision surgery, or patients with unusual anatomy where a stock implant cannot achieve optimal fit or alignment. It is used in the right patient — not routinely — when personalization is the difference between good and great.
Before deciding on fusion
Are you sure fusion is the only option?
Fusion is the right answer for many patients — and Dr. Katsevman performs it well when it is. But for the right candidate, one of these alternatives may preserve motion, avoid hardware, and deliver equal or better outcomes.
ProDisc-L FDA-approved for 1–2 levels. 300,000+ implantations. Nearly 4× less adjacent degeneration vs. fusion. Motion preserved. Learn more → 02 Stenosis + Grade I spondylolisthesis TOPS Procedure
Motion-Preserving Stabilization FDA Breakthrough Device. 77% vs 24% overall success vs. fusion at 2 years. No rods, no cages. Motion preserved in all planes. Learn more → 03 Stenosis · spondylolisthesis Tubular Laminectomy
No hardware, no fusion Up to 3 levels through one quarter-inch incision. Posterior structures preserved. Many spondylolisthesis patients avoid fusion entirely. Learn more →
The bottom line: Dr. Katsevman performs all of these procedures and selects the right one for each patient’s specific anatomy, diagnosis, and goals. If you have been told fusion is your only option and want to understand whether an alternative exists, a consultation is the right next step.
Common questions
What patients ask most
Will I lose flexibility after lumbar fusion? +
Not as much as most patients fear. Lumbar fusion at one or two levels typically produces a modest reduction in total spinal motion — but because the lumbar spine has multiple levels, the levels above and below compensate significantly. Most single or two-level fusion patients can still touch their toes (if they could before surgery), play golf, swing a pickleball paddle, garden, and exercise freely. What they lose is the grinding, instability, or pinching that was limiting them before. Fusion does not mean you stop moving — it means the painful, unstable segment stops moving abnormally.
What is the difference between ALIF, LLIF, TLIF, and PLIF? +
All four are lumbar interbody fusion procedures — they all place a spacer (cage) into the disc space to achieve fusion. The difference is the direction of surgical access: ALIF from the front, LLIF/XLIF from the side (also done prone as PTP), TLIF from the back-side, PLIF from directly behind. Each has specific advantages for particular levels, anatomies, and goals. ALIF and LLIF place the largest cages and spare the back muscles. TLIF and PLIF work at any level and allow simultaneous decompression but use a smaller cage. Dr. Katsevman will explain which approach is best for your specific anatomy at your consultation.
What is BMAC and why does it matter for fusion? +
BMAC (Bone Marrow Aspirate Concentrate) is a biologic augmentation drawn from the patient’s own bone marrow and concentrated to extract stem cells, growth factors, and bone-forming progenitor cells. Applied to the fusion site during surgery, BMAC provides the biological signal that accelerates and supports bone formation and healing. It is particularly valuable in patients who are at higher risk of fusion failure — smokers, diabetics, patients on long-term steroids, and those with prior unsuccessful fusions. It is derived from your own body, carries no rejection risk, and is offered as an optional add-on. It is not covered by insurance.
What is EOS imaging and why does it matter? +
EOS EDGE is a full-body, weight-bearing imaging system that captures the entire spine — from skull to feet — in a single standing image with dramatically less radiation than traditional X-rays or CT. For fusion planning, it provides measurements of key alignment parameters: lumbar lordosis, pelvic incidence, sacral slope, and global balance. These numbers guide the selection of cage lordotic angle, implant sizing, and rod contouring before surgery. A fusion that restores the wrong alignment can cause chronic back pain and adjacent segment disease even when the hardware is technically sound. EOS-guided planning prevents this. Not all fusion surgeons use it.
What is recovery like after minimally invasive lumbar fusion? +
Recovery varies by approach and number of levels fused. For minimally invasive single-level TLIF or ALIF, most patients are discharged in 1–2 days and walking the same day. Return to desk work is typically 2–4 weeks. Return to physical activity is guided by the fusion healing process — bone fusion takes 3–6 months to consolidate, and activity restrictions during this period are broader than after non-fusion procedures like disc replacement or laminectomy. Most patients are cleared for normal activity including sports at 3–6 months. Multi-level fusions and those requiring significant deformity correction may have a longer recovery.
What is the aprevo® implant and when does Dr. Katsevman use it? +
aprevo® is a patient-specific interbody implant 3D-printed from high-strength titanium, custom-designed from a CT scan of your individual spine. Unlike standard stock implants that come in fixed shapes and sizes, aprevo is engineered to match your exact vertebral contours and lordotic angle — eliminating the anatomic mismatch that affects 62% of spinal deformity patients treated with traditional implants. Dr. Katsevman offers aprevo in select cases: complex adult deformity, revision surgery where prior hardware or abnormal anatomy makes standard implants a poor fit, and situations where achieving the correct alignment requires a cage geometry that no off-the-shelf option can provide. It is a targeted tool for the right patient, not a routine offering for every fusion.
Will insurance cover lumbar fusion? +
Yes — lumbar fusion is covered by most major insurance plans when medically indicated. Coverage criteria vary by insurer and typically require documentation of failed conservative treatment, specific imaging findings, and clinical symptoms. BMAC is off-label and not covered. Dr. Katsevman’s team will verify your specific benefits, navigate prior authorization, and explore out-of-network options or GAP exceptions where applicable. We work with all insurance plans and are transparent about costs before any decisions are made.
"Fusion isn’t the enemy — poorly planned, poorly executed fusion is. When fusion is the right answer, the approach, the alignment planning, and the precision of the hardware matter just as much as the decision to fuse."
Gennadiy (Gene) A. Katsevman, MD
Neurosurgeon & Minimally Invasive Spine Surgeon
Fellowship-trained at Barrow Neurological Institute under Dr. Juan Uribe — world pioneer in minimally invasive spine surgery including MIS fusion
Neurosurgery residency, West Virginia University — Level 1 Trauma Center
Performs ALIF, LLIF/XLIF, PTP (Prone Transpsoas), TLIF, and PLIF — approach selected per patient anatomy and goals
EOS EDGE full-body alignment planning on every fusion case
Robotics and navigation on every fusion case
BMAC biologic augmentation available for fusion healing support
aprevo® patient-specific 3D-printed titanium implants available in select cases (complex deformity, revision, unusual anatomy)
30+ peer-reviewed publications in spine surgery and neurosurgery
Naples Top Doctor in Neurosurgery — 2024, 2025, and 2026
5-star Google rating · Healthgrades Choice Provider · WebMD Preferred Provider
Take the next step
If fusion is the answer —
let’s do it right.
Schedule a consultation with Dr. Katsevman in Naples or Fort Myers — or via telemedicine — to review your imaging and determine the right approach, the right alignment, and the right plan for you.
6101 Pine Ridge Road #101
Naples, FL 34119
Fort Myers, FL 33919
Available statewide & nationwide