Posterior Lumbar Interbody Fusion Surgery
If lumbar spine pain becomes so severe that it disrupts daily life or is accompanied by swelling, tenderness, or redness, it’s important to seek medical attention.
At Complete Orthopedics, our expert specialists are adept at treating lumbar spine pain through both surgical and non-surgical means. We examine symptoms, diagnose the condition, and recommend suitable treatments, including surgery if necessary.
Serving New York City and Long Island, we partner with six hospitals to offer cutting-edge lumbar spine surgery and comprehensive orthopedic care. You can schedule a consultation with our orthopedic surgeons online or by phone.
Learn about the common causes of lumbar spine pain and the treatment options available, including when surgery might be the best choice.
Overview
Posterior lumbar interbody fusion (PLIF) is a surgical procedure to fuse one or more vertebral segments in the lower spine done from behind the spine. The surgery usually involves the placement of a prosthetic cage to maintain disc space and aid the fusion.
Lumbar fusion surgery is usually done to relieve the pressure off the nerve roots which may be causing sciatica pain. The procedure is usually reserved when all forms of conservative management have been tried and failed.
The vertebrae in the human spine are stacked upon each other with the intervening discs. The vertebrae form a central canal that provides a conduit for the spinal cord and its covering. Spinal nerve roots exit the spinal canal through intervertebral foramina at each level to supply the target region. The vertebral body lies in front of the spinal canal, whereas the lamina lies at the back.
X-ray of the lumbar spine showing PLIF surgery.
Causes
Due to degenerative or traumatic conditions, the spinal nerves or the thecal sac contents may at times be compressed/irritated leading to radiating pain known as sciatica. In severe cases, the compression may also lead to weakness of the leg muscles or loss of sensation in the lower extremities. When the nonsurgical management of the lumbar radiculopathy fails, a posterior spinal fusion may help in alleviating the symptoms.
The degeneration of the disc and the facet joints in the spine may lead to back pain. A chronic back pain not amicable to nonsurgical management may be managed by lumbar fusion surgery.
Due to instability of the vertebral segment, the adjoining vertebrae may slip over one another, a condition which is known as scoliosis . The instability may result from trauma sustained in a fall or a motor vehicle accident or secondary to degeneration of the spine.
In some patients, the stabilizing structures of the spine may be absent by birth that may lead to instability. The instability is usually treated surgically in the form of a lumbar fusion with additional instrumentation in the form of screws and rods.
Deformity or misalignment of the vertebrae such as scoliosis may also be managed with posterior lumbar fusion surgery. Similarly, infections of the lower spine or some tumors may require management in the form of lumbar fusion. A failed back surgery previously performed from a different approach may be treated using a posterior lumbar fusion surgery.
Procedure
The lumbar interbody fusion surgery is performed from the back of the patient. After appropriate anesthesia, an incision is given along the midline of the involved segment. The surgeon carefully retracts the spinal muscles attached to the lamina and the transverse process. The lamina is then cut to expose the spinal nerve roots. The facet joint may be trimmed or cut to make more space for the nerve roots.
The nerve roots are retracted to one side to allow the visualization and removal of the intervertebral disc material. The intervertebral disc is removed and the adjoining surfaces of the vertebrae are freshened to introduce a prosthetic bone cage.
The bone cage ensures to maintain the distance between the vertebrae after removal of the disc. The bone cage also helps relieve the pressure off the spinal nerve roots.
Bone graft is then filled in the space between the vertebrae and the bone cage. The bone graft may be harvested from the patient during the surgery from the pelvic bone. The lamina and parts of the vertebrae removed during the surgery may also be used as a bone graft. A bone graft may also be utilized from the bone bank.
During the surgery, if instability of the vertebral segment is anticipated, pedicle screws may be inserted in the segment from the sides. A metallic rod is tightened over the screws to make a solid construct. The instrumentation ensures stability and early rehabilitation.
The instrumentation also helps in the early fusion of the involved vertebrae. The surgeon closes the incision in layers at the end of the surgery.
Complications
As with any surgical procedure, there may be medical complications such as blood clots, infection, myocardial infarction, respiratory failure. Specific to the procedure there may be complications of nerve damage, dural sac rupture, blood loss during the surgery. After the surgery, there may be complications of hardware subsidence, failure of fusion, radiculitis, etc.
Rehabilitation
The patients are usually motivated to walk the same day of the surgery or the day after. The patients may be observed in the hospital or discharged the same day of the surgery depending upon the level of fusion.
The patient may be instructed to avoid movements that may lead to hardware subsidence. After the initial post-operative period, physical therapy may be started to increase the strength and flexibility of the muscles of the lower back.
Posterior lumbar interbody fusion is a successful surgical option for patients with lumbar spine disease when indicated. The surgery may also be performed through minimally invasive techniques that utilize less cutting of the tissues to achieve fusion.
Conclusion
Posterior Lumbar Interbody Fusion (PLIF) is a well-established surgical procedure used to address various spinal conditions that cause pain and instability. By understanding the anatomy of the spine, the common causes for PLIF, the surgical procedure itself, and potential complications, patients can make informed decisions about their treatment options. The insights from recent research further underscore the importance of advancements in surgical techniques and post-operative care in improving patient outcomes. While every surgery carries risks, the benefits of PLIF in appropriately selected patients often outweigh these risks, leading to significant improvements in pain relief and quality of life.
Do you have more questions?
What exactly is Posterior Lumbar Interbody Fusion (PLIF)?
PLIF is a surgical procedure that involves fusing one or more vertebral segments in the lower spine. It is performed from the back of the spine and typically involves the placement of a prosthetic cage to maintain disc space and aid in fusion.
How does PLIF relieve pain?
The procedure stabilizes the spine and relieves pressure on the spinal nerves by removing the damaged disc and replacing it with a bone graft and a prosthetic cage, which helps maintain proper spacing and alignment.
Why would someone need a PLIF surgery?
PLIF is often recommended for conditions like degenerative disc disease, spinal instability, scoliosis, spinal deformities, infections, tumors, and cases where previous spinal surgeries have failed.
What are the risks associated with PLIF surgery?
Risks include blood clots, infection, heart attack, respiratory failure, nerve damage, dural sac rupture, blood loss, hardware failure, fusion failure, and radiculitis.
How long does the surgery take?
The duration of PLIF surgery varies but typically takes between 3 to 6 hours, depending on the complexity of the case.
What type of anesthesia is used during PLIF?
General anesthesia is used, meaning the patient will be completely asleep and unaware during the procedure.
What is the recovery time after PLIF surgery?
Initial recovery usually takes a few weeks, but complete healing and fusion can take several months. Physical therapy is often required to aid in recovery.
Will I need to stay in the hospital after the surgery?
Yes, most patients stay in the hospital for a few days post-surgery for monitoring and initial rehabilitation.
What kind of physical therapy is required after PLIF?
Physical therapy focuses on strengthening the muscles of the lower back, improving flexibility, and gradually increasing activity levels to aid in recovery and prevent future issues.
How soon can I return to work after PLIF surgery?
This depends on the nature of your job and your individual recovery. Generally, patients may return to sedentary work within 4 to 6 weeks, but physically demanding jobs may require a longer recovery period.
How effective is PLIF in treating chronic back pain?
PLIF is generally effective in treating chronic back pain associated with conditions like degenerative disc disease and spinal instability, with many patients experiencing significant pain relief.
Can PLIF be performed using minimally invasive techniques?
Yes, advancements in surgical techniques have made minimally invasive PLIF possible, which involves smaller incisions and potentially quicker recovery times.
What is the success rate of PLIF surgery?
Success rates vary but are generally high, with many patients experiencing significant improvement in pain and function. Success depends on factors like the underlying condition, patient health, and adherence to post-operative care.
Will I need to wear a brace after PLIF surgery?
Some patients may be advised to wear a brace to support the spine during the initial healing period, but this depends on the surgeon’s recommendation and the specifics of the surgery.
How is a bone graft obtained for the procedure?
Bone grafts can be harvested from the patient’s own pelvis (autograft), obtained from a bone bank (allograft), or sometimes synthetic materials are used.
Can I drive after PLIF surgery?
Driving is generally not recommended for at least a few weeks post-surgery, as it can strain the surgical site and may be unsafe due to pain or restricted movement.
What happens if the fusion does not take?
If the fusion does not occur, additional surgery may be required. This can involve adding more bone graft material, adjusting the hardware, or other techniques to achieve proper fusion.
Is it normal to have pain after PLIF surgery?
Some pain and discomfort are normal after surgery, but it should gradually improve. Persistent or severe pain should be reported to your surgeon.
How will I know if the surgery was successful?
Success is typically measured by a reduction in pain, improvement in function, and evidence of fusion on imaging studies during follow-up visits.
What should I do if I experience complications after surgery?
Contact your surgeon immediately if you experience symptoms like severe pain, swelling, fever, or any signs of infection or neurological issues.
Can PLIF surgery be performed on multiple levels of the spine?
Yes, PLIF can be performed on multiple levels if necessary, depending on the extent of the spinal issues and the surgeon’s assessment.
How can I prepare for PLIF surgery?
Preparation involves medical evaluations, possibly stopping certain medications, arranging for post-operative care at home, and following pre-surgery instructions provided by your healthcare team.
My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.
I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.
My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.
