PLIF: Posterior Lumbar Interbody Fusion
What is PLIF: Posterior Lumbar Interbody Fusion?
Posterior Lumbar Interbody Fusion (PLIF) is a common form of surgery that can effectively provide relief from enduring or debilitating pain in the lower back, known as the lumbar region. PLIF is performed by gaining access to the spine through the patient’s back, or posterior part of the body. A posterior approach may be advantageous since it avoids many organs and major blood vessels present in the abdominal region and it may be closer to the affected site. An interbody fusion technique involves removing an interverterbal disc, inserting a bone spacer to maintain disc height and fusing the vertebrae on either side together.
PLIF is often a successful treatment method for numerous lower back problems, such as spondylothesis and disc space collapse, that have not responded to conservative therapies. Prior to the procedure, detailed images of the spine will be produced using MRI and CT scans. This allows Dr. Lipani to pinpoint the exact location of the problem in the spine as well as establish the most appropriate type of implant for correction.
The PLIF Procedure
The PLIF procedure is performed with the patient under general anesthesia and positioned lying face down on the operating table. The treatment site is cleansed with an antiseptic and Dr. Lipani makes a three- to six-inch incision in the midline of the back near the affected portion of the spine. Tools are used to separate and retract the muscles. An imaging device will ensure that the precise vertebrae are targeted. Next, the lamina is removed and any excess bone in the way will be trimmed back to obtain an unobstructed view of the nerve roots. The injured disc, bone spurs and any existing fragments are then removed. This restores room for the nerves that have been compressed, relieving pain and symptoms in the lower back and legs.
To fill the space that has been created, a bone graft or bone morphogenetic proteins are then placed in the open disc area and instrumentation is affixed as needed to maintain spinal stability. The hardware used often includes two spacers containing the graft material, with one positioned on each side of the interbody space. Dr. Lipani carefully inserts the spacers, avoiding the spinal cord and nerves present nearby. In addition, metal plates, rods and screws will be attached to the vertebrae to hold the spinal bones in place while fusion is occurring.
Bone morphogenetic protein (BMP) is an FDA-approved treatment used in conjunction with spinal fusion surgery to stimulate bone growth within the treated area and achieve optimal results without the need for a bone graft. However, bone grafts taken from another part of the patient’s own body or obtained from donor bone are also highly successful.
Once complete, imaging is used again to confirm the placement of the spacers and instrumentation. The surgeon can then close up the incision with sutures or surgical staples. The PLIF surgery may vary in length, generally lasting between three and six hours, depending on the extent of the damage in the spine.
Recovery from a PLIF Procedure
After undergoing a PLIF procedure, patients will typically remain in the hospital for three to five days. A physical therapy regimen should be started soon after, as it is beneficial for regaining strength and full mobility. Certain activities may be restricted, including lifting objects, twisting the midsection and bending at the waist. Many patients can return to work two to three weeks following the procedure if their employment does not require strenuous exertion. After three months, patients may be cleared to resume some sports and more rigorous activities, but this will depend on the number of vertebrae fused during the surgery as well as each patient’s individual healing process.
Risks of a PLIF Procedure
While PLIF is considered a safe procedure, it is still a form of spinal surgery and it therefore carries some risks. While uncommon, the most frequent complication is nonunion, which means the bones do not fuse together properly. This is more likely to occur in those who smoke, are obese, had previously undergone a spinal or fusion surgery or received radiation treatments. Nonunion may result in the necessity of another spinal procedure. Other risks of PLIF are rare and may include persistent pain, infection and bleeding.