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.
Who are the candidates for posterior lumbar interbody fusion surgery?
This surgery with Dr. Lipani is necessary when a patient has ongoing serious back pain that has not responded to conservative treatment options. A PLIF is used to correct a variety of spine problems, including degenerative disc disease, disc herniation, spinal stenosis, scoliosis, and spondylolisthesis.
The goal of this surgery is to decrease the chronic pain in the patient, correct spinal deformity, and eliminate movement between the two fused vertebrae. These procedures are commonly performed on the L4-L5 vertebrae or the L5-S1 segment at the bottom of the lumbar spine.
What are the Benefits of PLIF surgery?
By entering through the patient’s back, posterior lumbar interbody fusion has various benefits:
- The vertebrae are more easily exposed — Because Dr. Lipani seeks to remove the lamina at the back of the two vertebrae to be fused, entering from the posterior aspect provides much more exposure. This makes it easier to remove the lamina and the herniated disc material to decompress the neurological pathways.
- Larger space for bone grafts — The PLIF approach provides maximum space for the bone grafts to heal. That’s because the surface area involved in doing a PLIF will be much bigger than available in other approaches. With grafting, a bigger surface area is ideal for successful fusion.
- Avoids organs and blood vessels — Entering through the posterior side allows Dr. Lipani to avoid many organs and major blood vessels present in the abdominal region. This decreases the possible risk of unforeseen complications.
- High success rates — Success rates for these fusion procedures are from 90-95 percent.
What are the 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.
How should I prepare for Lower Back Surgery?
You’ll need to prepare for a PLIF procedure as you would any surgery. This means telling Dr. Lipani all current medications you are taking, stopping the use of blood thinners, aspirin, anti-inflammatory medications, and most supplements for one week prior to your surgery. If you smoke, you’ll need to stop for at least two weeks before and after your surgery. We’ll instruct you when you need to fast before your surgery, as you will be under general anesthesia.
The main preparation here is for your recovery. You won’t be able to lift more than about 8 pounds for several weeks after your surgery, so you’ll need to account for this. You’ll definitely need help around the house for a period of weeks, and this needs to be arranged.
You’ll need to make changes in your house to prepare:
- Toilet riser — It can be difficult to get on or off the toilet in the weeks after this surgery. A riser simply raises the height of the seat by about 8 inches.
- Arrange your recovery space — You won’t be able to bend over to access many items, such as dishes and cups, or toiletries. Put these on the counter for easy access. Same for clothes you’ll be wearing in the beginning.
- Get a grabber or reacher — These 2- to 3-foot-long devices may become your favorite thing in your house other than the TV remote and your pile of books. These allow you to pick up things from the floor or other areas quite easily.
- Stock the freezer — You won’t want to have to prepare food. So, unless you have someone who will do that for a period of time, it’s a good idea to either prepare and freeze meals or buy prepared frozen meals.
- Slip on shoes — You won’t be able to bend down to tie your shoes. Slip ons are a must.
You’ll need to remember that placing stress on your fused vertebrae is to be avoided for a period of weeks. We’ll help you with other preparations to ensure this doesn’t happen.
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.
What Our Patients Have to Say
“Dr. Lipani is the finest neurosurgeon! Compassionate, Caring, Down to Earth with his professionalism; he is the best! My son Alan, had an L-4/ L/5 Spine Fusion, 7.5 hour surgery and I can not thank the “Great Doctor”/Surgeon for his dedication, kindness and caring.” – Alan B.
“The Doctor outstanding in every way possible. Explaining every detail and taking his time to do so. Amazing for a surgeon to be so informing of the procedure to me and my wife. After the surgery he came out and explained everything to me. My wife is doing great after the cervical spine fusion, moving her arm in ways she hasn’t in years and getting her feeling back in her fingers” – Anthony R.
“Dr. Lipani and his staff are excellent. Dr. Lipani was very thorough. He explained what needed to be treated and why. He has terrific bedside manners. He answered all my questions patiently. Did not rush me at any time. I recommended him to one of my friends and she was extremely happy with him too.” – Poornima S.
Lower Back Surgery Recovery Time
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.
How long does it take for the vertebrae to fuse together after a PLIF surgery?
Success rates for these fusion procedures are quite high, from 90-95 percent. But it doesn’t happen overnight. Different patients have different rates of growth in the bone grafts, but it’s generally assumed that it takes from 3 to 6 months for the two vertebrae to fully fuse together into one solid piece of bone. You will start an exercise program somewhere between 6 weeks and 3 months after your surgery, depending on your healing rate. At a point in the bone fusion process, exercise actually helps with the fusion.
How painful is recovery after Lower Back surgery?
You will have pain medication in the hospital during your stay of 2-3 days. From there, you will move home or to a rehabilitation facility and you will transition to prescription pain medication. There is usually no need for further use of opioid pain medication after 2 to 3 weeks. In most cases, the worst pain is over after at most 4 weeks after surgery. Although your pain will decrease, some patients can continue to have some amount of pain for 3 to 6 months after surgery. This varies dramatically with different patients.