Posterior Lumbar Interbody Fusion (PLIF)
Posterior Lumbar Interbody Fusion (PLIF)
Traditionally, there are a few ways to fuse the spine. One of these ways is known as interbody fusion. Interbody fusion is fusion of two vertebrae between the vertebral bodies (main trunk of the vertebra) in the anterior column (front part of the spine).
In order to fuse two vertebrae together using interbody fusion, the intervertebral disc in the front of the spine must first be removed. In the space created by the removal of the disc, an implant, such as a spacer or cage, will be inserted to help maintain the normal alignment of the spine. Additionally, a bone graft (real pieces of bone used to stimulate bone growth) or bone graft substitute (natural or synthetic material used to replace bone tissue and stimulate bone growth) will be placed in the space made between neighboring vertebrae to help them fuse together.
Doing a pure posterior lumbar interbody fusion (PLIF) surgery has the advantage that it can provide anterior fusion of the disc space without having a second incision as would be necessary with an anterior/posterior spine fusion surgery. However, it has some disadvantages:
- Not as much of the disc space can be removed with a posterior approach (from the back).
- An anterior approach (an ALIF, from the front) provides for a much more comprehensive evacuation of the disc space and this leads to increase surface area available for a fusion.
- A larger spinal implant can be inserted from an anterior approach, which provides for superior stabilization.
- In cases of spinal deformity (e.g. isthmic spondylolisthesis) a posterior approach alone is more difficult to reduce the deformity.
- There is a small but finite risk that inserting a cage posteriorly will allow it to retro pulse back into the canal and create neural compression.
PLIF surgery has a higher potential for a solid fusion rates than posterolateral fusion rates because the bone is inserted into the anterior portion (front) of the spine.
Improvement in preoperative symptoms is achieved in about 80% of patients. The improvement in back pain and function continues up to 2 years after spine fusion surgery. The rate of improvement depends on:
- The ongoing maturation of the fusion mass
- Recovery of the nerve compression
- Conditioning of the muscles after spine surgery
Another key factor that impacts recovery after spine fusion surgery is smoking. Nicotine acts like a poison in the bone, inhibiting fusion of the bone. Studies show that spinal fusion in patients who smoke has the highest rate of not fusing the bone, while spinal fusion in patients who do not smoke have almost half the rate of a non-union (not fusing).
During the initial few months following a spine fusion, it is best to avoid excess motion and stress at the fused segments. It is during this time that the fusion bone mass is becoming established. Certain types of movement to avoid include:
- Excess lifting (anything over 10 to 15 pounds)
Sometimes the surgeon may prescribe a back brace to help immobilize the back. If a back brace is prescribed, it is typically recommended to wear it for 6 weeks to 3 months after surgery.
At the same time, it is important to resume normal daily activities. However, there may be some activities, either at home or at work, which should not be done. If your job includes physical activities, then you may not return to work, sometimes even for six months.
After the trauma of surgery, the muscles of the trunk, as well as your overall condition, are compromised. At approximately 3 months after surgery, a progressively more aggressive exercise program is typically started. This is often begun with the guidance of a physical therapist.
However, progress will not be accomplished unless the patient makes the effort. The long-term good results of a spine fusion require that the patient participate in a long-term self-directed exercise program.
If you have any questions contact any of our office locations conveniently located to the Dallas, Irving, Red Oak, Plano, Southlake, Grapevine, Colleyville and Duncanville areas.
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