Posterior Lumbar Interbody Fusion

What is Posterior Lumbar Interbody Fusion?

Posterior Lumbar Interbody Fusion (PLIF) is a type of spinal surgery that aims to relieve pain, numbness, tingling, and weakness by stabilising the spinal vertebrae and disc between them. The "posterior" refers to the procedure performed from the body's back (or posterior) side. "Lumbar" denotes the lower portion of the spine, "interbody" refers to the area between the vertebrae containing the disc, and "fusion" pertains to the process of fusing two bones. 

The primary goal of this surgery is to remove a disc from between two vertebrae and fuse them to alleviate the symptoms caused by conditions like degenerative disc disease, spondylolisthesis, or herniated disc.

Who is Suitable for Posterior Lumbar Interbody Fusion?

Suitability for PLIF is determined on a case-by-case basis, but generally, you might be a candidate for PLIF if:

• Conservative treatments have failed: PLIF is typically recommended when less invasive treatments, like physical therapy, medication, or injections, haven't relieved your symptoms.
• You have identifiable pathology: PLIF is used to treat specific conditions that can be identified on an imaging test, like a herniated disc, degenerative disc disease, spondylolisthesis, or in some cases, scoliosis. It's most effective when the surgeon can pinpoint the exact source of your pain and address it directly.
• You're in good overall health: As with any surgical procedure, you must be healthy to tolerate the surgery and subsequent recovery process. This includes having no uncontrolled heart, lung, or other systemic diseases.
• You're willing and able to participate in post-surgery rehabilitation: Successful PLIF treatment includes a commitment to post-surgery rehabilitation. This can involve physical therapy, lifestyle changes, and the use of braces or other supportive devices.

Benefits of Posterior Lumbar Interbody Fusion

• Pain Relief: One of the main goals of PLIF is to alleviate chronic back pain that hasn't responded to non-surgical treatments. Many patients experience significant pain reduction after the surgery.
• Improved Mobility: By stabilising the spine, PLIF can help improve mobility, improving quality of life.
• Increased Stability: PLIF aims to increase the spine's stability by fusing vertebrae, which can be particularly beneficial when the spine becomes unstable due to conditions like spondylolisthesis.
• Nerve Decompression: In conditions like herniated discs or spinal stenosis, where nerve roots may be compressed, removing the problematic disc during PLIF can relieve pressure on these nerves, alleviating associated symptoms like pain, numbness, or weakness in the limbs.

Types of Posterior Lumbar Interbody Fusion:

• Traditional PLIF: Involves a larger incision and direct visual access to the spine.
• Minimally Invasive PLIF (MI-PLIF): This technique uses smaller incisions, and the surgeon uses special tools and imaging technology to access the spine with minimal tissue disruption.
• Transforaminal Lumbar Interbody Fusion (TLIF): A variation of the PLIF where the approach is slightly more from the side, aiming to reduce nerve root manipulation.

Alternatives to Posterior Lumbar Interbody Fusion:

• Anterior Lumbar Interbody Fusion (ALIF): Similar to PLIF, the surgeon approaches the spine from the front (anterior) of the body.
• Lateral Lumbar Interbody Fusion (LLIF): Also known as Extreme Lateral Interbody Fusion (XLIF), the procedure involves approaching the spine from the side.
• Non-surgical treatments: Depending on the condition, non-surgical treatments such as physical therapy, medications, injections, or lifestyle modifications may be effective.
• Disc Replacement: Instead of fusing the vertebrae, an artificial disc can be inserted to maintain spinal mobility.
• Laminectomy or Discectomy: In some cases, removing a portion of the vertebra (laminectomy) or the disc (discectomy) can relieve symptoms without needing fusion.

Each of these alternatives has its benefits, risks, and contraindications. Therefore, it's essential to have a thorough discussion with a neurosurgeon about the best option for your specific condition.

What to do Before a Posterior Lumbar Interbody Fusion?

Tell Prof Malham about any medical conditions or previous operations. Suppose you have a medical condition such as diabetes, heart problems, high blood pressure or asthma. In that case, Prof Malham may arrange for a specialist physician to see you for a pre-operative assessment and medical care following the neurosurgery. 

Inform Prof Malham of the medication you are taking and/or have allergies to medications. You must stop using the following ten days pre-operatively: 

• Aspirin
• Plavix
• Isocover
• Asasantin

You must stop using blood thinning medication (such as Warfarin) 3-5 days pre-operatively. 

Posterior Lumbar Interbody Fusion Procedure

• Anaesthesia: You'll be given general anaesthesia, so you'll be asleep and not feel any pain during the surgery.
• Positioning: After administering anaesthesia, you will be carefully positioned on your abdomen on the operating table.
• Incision: The surgeon will make an incision in the middle of your lower back. The incision size may vary depending on whether traditional or minimally invasive techniques are used.
• Disc Removal: The surgeon will remove the muscles and other structures to expose your spine. Using special instruments, the surgeon will remove the problematic disc and any fragments pressing on the nerve roots.
• Graft Insertion: A bone graft or a cage filled with bone graft material is placed into the empty disc space. This promotes bone growth and facilitates fusion.
• Stabilisation: The vertebrae above and below the disc space may be stabilised using screws and rods.
• Closure: Once the fusion material is in place, the surgeon will place the muscles and tissues back and close the incision.

What to Expect After a Posterior Lumbar Interbody Fusion?

The surgery typically takes several hours to complete. After the surgery, you'll be moved to a recovery room, where healthcare providers will monitor your vital signs as you wake up from anaesthesia.

Recovery Plan for Posterior Lumbar Interbody Fusion

• Pain Management: This is a key part of your recovery. You may be prescribed medications to manage post-operative pain. Over time, the need for these medicines should decrease.
• Physical Therapy: A physical therapist will help you with exercises to strengthen your back and improve your mobility. This is an important part of your recovery and can help to improve your long-term outcomes.
• Regular Follow-ups: Regular visits to your healthcare provider will help monitor your progress and make sure your recovery is on track.
• Healthy Lifestyle: Maintaining a healthy lifestyle will aid your recovery. This includes eating a balanced diet, stopping smoking if you smoke, and getting regular exercise once your doctor clears you.
• Back Care: Taking care of your back after surgery is important. This may involve using proper techniques when you lift, move, or carry objects; avoiding excessive bending, twisting, or reaching; and maintaining good posture.
• Patience: It's important to understand that recovery from spine surgery can take time. It may take several months for the bone to fuse fully, and during this time, you may have some limitations on your activities.

Posterior Lumbar Interbody Fusion Prognosis

Many patients experience significant pain reduction and improved quality of life after recovery. However, it's crucial to remember that full recovery can take time - it may take several months for the bone to fuse fully. During this period, you might have some limitations on your activities.

Posterior Lumbar Interbody Fusion Risks

As with any surgery, PLIF comes with potential risks, which include:

• Infection: This can occur at the surgery site and may require treatment with antibiotics or sometimes additional surgery.
• Bleeding: As with any surgical procedure, there's a risk of bleeding. In rare cases, a blood transfusion may be required.
• Nerve damage: There's a small risk of nerve damage during the surgery, which could lead to weakness, numbness, pain, or bowel/bladder problems.
• Nonunion (Failed Fusion): Sometimes, the bone graft does not fuse the vertebrae as intended. This might require additional surgery.
• Hardware Complication: The screws or rods used for stabilisation can sometimes move or break, which may require another surgery.
• General Anesthesia Risks: These include reactions to the anaesthesia, breathing problems, heart complications, stroke, and in very rare instances, death.

Delaying Posterior Lumbar Interbody Fusion

If non-surgical methods effectively manage your pain and other symptoms, delaying surgery may not lead to additional complications.

However, if your symptoms are severe, progressively worsening, or if you're experiencing serious complications like loss of bowel or bladder control, significant weakness or numbness, or if your spine is becoming more unstable, delaying surgery may lead to a progression of these symptoms or complications.

Waiting for a long period could complicate the surgery or reduce effectiveness. You should discuss this with your neurosurgeon, who can provide advice tailored to your situation.