Posterior Lumbar Interbody Fusion (PLIF)
Posterior = From the back
Lumbar = Low back, involving one or more of the last 5 intervertebral discs.
Interbody = Into the disc space.
Fusion = A bone graft is placed over spinal bone. When the bone graft grows into the existing bone, the “fusion” is solid and movement is eliminated at that level.
What Are Some Of The Reasons I Might Need A Posterior Lumbar Interbody Fusion?
- A fusion may be considered when your diagnosis is degenerative disc disease, internal disc disruption, or unstable spine.
- An unstable spinal column allows one vertebral body to slip forward or backward above or below adjacent vertebra. This movement narrows the foramen, putting painful pressure on nerve roots.
- Normal aging or trauma may cause changes in the bones and discs in the vertebral column, leading to a cascade of conditions that can affect nerve roots. This may cause back pain and sometimes nerve damage.
- A problem inside the disc, Internal Disc Disruption, causes pain in the spine; this is believed to be due to leakage of irritating chemicals from the disc.
- Back pain may be a primary complaint, and may be accompanied by hip and leg pain.
- The interbody fusion may also be indicated when there is residual back pain after surgical removal of a disc herniation.
Advances In Spine Fusion Technology
Research has resulted in new technology for treating back pain. There are a number of threaded titanium cages approved by the FDA that offer the following advantages over previous fusion techniques:
Cages are made of titanium, a light-weight, strong metal that is rarely rejected. The procedure is less invasive, thereby reducing recovery time and providing greater pain relief. It may be possible to do this with a laparascope. Cages restore the disc space to near its original height, thus relieving pressure on nerve roots. The threaded aspect of the cage provides instant stability while the bone grows to complete the fusion. Return to activity is sooner, and activity levels are significantly increased. There is an overall lower complication rate.
How Cages Are Used During Surgery:
During surgery, most of the painful disc is removed and the titanium cages are inserted into the disc space.
Cage size is selected to restore normal disc height in order to take pressure off compressed nerves. One of several substances may be placed inside the cages-your own bone (taken from the iliac crest of your hip), bone bank bone, (donated bone), or bone morphogenic protein, which is currently under FDA investigation, requiring participation in a research study.
As bone grows through the holes in the cage, fusion occurs, joining the vertebral bodies above and below. This results in a single joint rather than the previous one or two joints, depending upon the number of levels requiring surgery.
How Is The Surgery Done?
Under general anesthesia, an incision 6″ to 10″ will be made in the back, through the muscles, down to the spine. The lamina will be removed, all or in part (this is the laminectomy part of the surgery), which then allows good access to the vertebral bodies, discs, and nerve roots.
Most of the disc (85 % to 95%) will be removed thereby removing pressure from the nerves. A “spacer,” bone, or cages, will be inserted into the space between the vertebrae where the disc used to be in order to maintain appropriate room for nerves to exit. Bone will grow through holes in the cages, fusing the vertebral body above the disc to the one below.
If bone is used from the hip or from the bone bank, it will grow together, or fuse, with existing bone. The result is the same in either case: the spine is stable and pressure is taken off the nerves.
Additional posterior stabilization may be used with metal, such as rods and pedicle screws. (The use of hardware or instrumentation is sometimes the best option your surgeon has to obtain the best results. This is a confusing area as there are issues involving how the instrumentations are classified by the FDA. In some instances the indications may differ from the ones on the manufacturer’s label. Be sure and ask your surgeon to explain this to you before surgery if you are not clear on the plans.)
The incision is closed and the patient is taken to the recovery room. Surgery for one disc usually takes 2 to 2.5 hours. Additional levels can take as long as 3 hours total surgery time. Hospital stay is usually 2-3 days.
There Are 4 Possible Outcomes From Any Surgery
- Your symptoms or pain may be completely improved.
- Your symptoms or pain may be partially improved.
- Your symptoms or pain may be the same as before surgery-no better.
- Your symptoms or pain may be worse than before surgery.
Please discuss any concerns with your physician.
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