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Posterior Lumbar Interbody Fusion

A Comprehensive Guide by the Brain and Spine Neurosurgical Institute

Overview of a Posterior Lumbar Interbody Fusion Operation

If you're dealing with persistent lower back and leg discomfort due to spinal instability, relief might be closer than you think. This comprehensive resource will walk you through a Posterior Lumbar Interbody Fusion surgery, delve into spine anatomy, outline the procedure's steps, and offer post-operative guidance. Our goal is to empower you with the knowledge needed to make informed decisions about your treatment.

Understanding a Posterior Lumbar Interbody Fusion

A Posterior Lumbar Interbody Fusion (PLIF) is used for any condition that is associated with spinal instability. Spinal instability is the abnormal motion of the bones in the spine. This instability may cause pain, numbness and/or muscle weakness in the lower back, hips and legs. These conditions include degenerative disc disease, spondylolisthesis (a slippage of one bone on another) and spinal stenosis.

A posterior lumbar interbody fusion joins two or more bones (vertebral bodies) in the lower spine together in order to stop abnormal motion at that area.  This is accomplished with the use of different forms of bone which act as the bridge between the vertebral bodies. Instrumentation is typically used to hold everything together until bony growth (fusion) is obtained. This surgery is performed after conservative measures have failed or if there is a significant neurologic deficit such as weakness.

Patients seeking a posterior lumbar interbody fusion operation often present with pain radiating down back and out into their legs. This pain is often due to the compression of a nerve. Often, we can identify the source of this pain by looking at an MRI. 

The spine is made up of a group of vertebrae, or small bones, stacked one on top of the other. These vertebrae are separated by cartilage, a spongy material that provides cushioning between the bones. 

In the picture above, the vertebrae are brown and the cartilage is white. The vertebrae surround and protect the spinal cord which is seen in yellow. The spinal cord, which is made up of a collection of nerves, is encased in cerebrospinal fluid which acts as another protective layer. 

There are several conditions that might lead a patient to consider a Posterior Lumbar Interbody Fusion.

1. Disc herniation: The disks of cartilage between our vertebrae are constantly supporting our entire body weight. Over time, this pressure can result in one of these discs being forced out of place and into the spinal canal. As it bulges, this disk may press against a spinal nerve and cause leg pain. During a PLIF, the surgeon will remove the entire herniated disc and then use rods and a cage to provide structure to the spinal cord.

2. Spondylolisthesis: Spondylolisthesis is characterized by the displacement of a certain vertebrae in relation to the vertebrae below it. Patients with this diagnosis often experience significant back and leg pain. 

3. Degenerative Disc Disease: Degenerative disc disease can also be treated with a PLIF. Patients with this condition experience the thinning and degeneration of cartilage in between their vertebrae. This often results in pain in the back buttocks or thighs, especially while walking. Once again, a Posterior Lumbar Interbody Fusion provides structure and support for the vertebrae.

Our surgeons complete a PILF with the patient lying on his or her stomach. A vertical incision is made at the site of the spinal cord impingement. Surrounding muscles are held aside to gain access to the laminae. A drill is used to remove the bone that surrounds the obstructed portion of the spinal cord. If the patient is suffering from a herniated disc, we target specific locations to remove the entirety of the disc. This process is known as a discectomy. 

The Fusion Process

We then restructure the spinal canal using a fusion process. This begins by drilling into the bone; it is completed carefully so as to not disturb any surrounding structures. We then place a fusion cage which will help the fusion of the vertebrae to progress quickly. Small pieces of bone collected during the procedure are then placed around the cage to further aid the fusion. Rods and screws are added to structure the spinal cord during the healing process. 

Over time, the cage and these pieces of bone will fuse with the vertebrae above and below the site of the discectomy. By promoting the fusion, or joining of these vertebrae, the patient is able to regain mobility and flexibility in his or her back.

Post Surgery

• The surgery will last between 3 to 6 hours, depending on the number of vertebrae to be fused. 

• Patients generally stay in the hospital for one to two days after their surgery. 

• Exercise is encouraged one to two weeks after surgery. It is best to start with walking and to avoid any twisting or bending. 

• Patients can expect to wear a back brace for up to six weeks after their procedure 

Back Brace

Please watch the video below to familiarize yourself with back bracing. 

Summary

• Braces are typically worn after lumbar fusion or laminectomy procedures

• The purpose is to add stability to your spine while you recover from surgery

• Braces can be adjusted to make sure that the brace is snug around your lumbar spine

• Use tabs and velcro to make adjustments

• Wear braces when you’re standing up, not sitting or lying down

• Usually wear for 6 weeks

Wound Care

Following your surgery, watch our video on correct wound care.

We provide specialized physical therapy exercises after completing your surgery. These therapies promote effective recovery and healing.

Watch the Video

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