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Posterior Lumbar Interbody Fusion

 

What Is a Posterior Lumbar Interbody Fusion?

Spinal fusion is a surgical procedure that is used to correct problems with the small bones in the spine. The goal is to fuse together the painful vertebrae, so they heal together into a single, solid bone. Spinal fusion is the best treatment option when motion is the main source of pain. 

In a posterior lumbar interbody infusion (PLIF), your surgeon inserts the spacer or cage from the back of the spine. With this approach, they gain access to the spine by removing the lamina (bone) and then retracting the nerve roots to one side. Then, the back of the intervertebral disc can be removed, and a spacer can be inserted.

Causes for a Posterior Lumbar Interbody Fusion

PLIF can be used to treat several common conditions that cause low back pain or radiating leg pain, including:

  • Degenerative disc disease
  • Sciatica
  • Spinal instability
  • Spinal stenosis
  • Recurrent disc herniation
  • Scoliosis

Preparing for a Posterior Lumbar Interbody Fusion

Before surgery, your provider will perform a physical exam and review medical history. You may also be scheduled for presurgical tests, like blood tests, ECG, or chest X-rays prior to the procedure. Some medications may need to be continued or stopped the day of surgery. Stop taking all non-steroidal anti-inflammatory medicines and blood thinners 1-2 weeks prior to surgery. Additionally, stop smoking, chewing tobacco, and drinking alcohol 1 week before surgery and 2 weeks after surgery as they can cause bleeding problems. No food or drink is permitted past midnight the night before surgery.

The morning of surgery, you should:

  • Shower using anti-bacterial soap.
  • Dress in freshly washed, loose-fitting clothing.
  • Wear flat-heeled shoes with closed backs.
  • Take medications (if instructed to do so) with small sips of water.
  • Remove make-up, hairpins, contacts, body piercings, and nail polish.
  • Leave all valuables and jewelry at home.
  • Bring a list of medications with dosages and times taken.
  • Bring a list of allergies to medications or food.

What to Expect in a Posterior Lumbar Interbody Fusion

During the procedure, your provider makes an incision in the middle of the lower back at the impacted level. The muscles are moved to the side to expose the affected vertebrae, and the lamina of that vertebrae is removed to the spine and nerve root can be viewed and decompressed. The nerves can then be retracted to expose the back of the intervertebral disc space. A portion is then removed, and the interbody cage can then be place in the empty disc space to promote fusion. Hardware, such as screws and rods, can be placed to maintain decompression and promote fusion.

The total recovery time can range from 6-12 weeks but varies from patient to patient. Although the incisional pain often goes away within the first few days, you can expect lower back soreness for 2 – 4 weeks after surgery. Patients are encouraged to walk as soon as they feel ready. Your provider will instruct you on when to start physical therapy or any other post operative treatments.

Following your fusion:

  • Do not take steroidal anti-inflammatory drugs (ibuprofen, aspirin, Advil, Motrin, Aleve) for six months after surgery. These may cause bleeding and interfere with bone healing.
  • Do not drive for 2 to 4 weeks after surgery or until discussed with your provider.
  • Avoid sitting for long periods of time.
  • Do not lift anything heavier than 10 pounds. Do not bend or twist at the waist.
  • Housework and yardwork is not permitted until the first follow-up office visit.
  • Postpone sexual activity until your follow-up appointment.
  • Do not smoke. Smoking delays healing by increasing risk of complications and inhibits the bones’ ability to fuse.
  • You may need help with daily activities for the first few weeks. Fatigue is common.
  • Gradually return to normal activities.
  • Know how to wear your brace. Wear for daily activities unless instructed otherwise.
  • You may shower 4 days after surgery.

Risk Factors of a Posterior Lumbar Interbody Fusion

No surgery is without risks. Besides the general complications of bleeding, infection, blood clots and reaction to anesthesia, there are specific complications related to a decompression, including:

  • Vertebrae failing to fuse – among many reasons why vertebrae fail to fuse, common ones include:
  • Deep vein thrombosis – potentially serious condition caused when blood clots form inside the leg veins. If the clots break free and travel o the lungs, lung collapse or even death is a risk. To prevent DVT, get up and move out of bed as soon as possible to allow your blood to start moving. Support hose can keep blood from pooling in the vein.
  • Hardware fracture – the metal screws, rods and plates used to stabilize your spine are called “hardware”. The hardware may move or break before your vertebrae care completely fused. If this occurs, a second surgery may be needed to fix or replace the hardware.
  • Bone graft migration – in rare cases, the bone graft can move from the correct position between the vertebrae soon after surgery. This is more likely to occur if hardware is not used or if multiple vertebral levels are fused.
  • Transitional syndrome – fusion of a spine segment causes extra stress and load to be transferred to the discs and bones above or below the fusion. The added wear and tear can eventually degenerate and cause pain.
  • Nerve damage or persistent pain – Any operation of the spine comes with the risk of damaging nerves or the spinal cord. Damage can cause numbness or even paralysis. The most common cause of persistent pain is nerve damage from the disc herniation itself. Some disc herniations may permanently damage a nerve, making it unresponsive to decompressive surgery. In these cases, your provider may recommend alternate treatment options, like spinal cord stimulation.

If your temperature exceeds 101°F, or if the incision begins to separate or show signs of infection, contact your healthcare provider immediately.