PLIF
A type of spinal fusion surgery performed from the back.
Find out more about PLIF or spinal fusion surgery whereby the incision is made from your back
PLIF key points
- PLIF or Posterior Lumbar Interbody Fusion is a type of spinal fusion whereby the incision is made in the middle of your back
- Computer-guided systems and 21st-century technology have made PLIF a safe and effective procedure.
PLIF | Spine surgery Brisbane
The spine surgeon said PLIF. What exactly is that?
PLIF stands for Posterior Lumbar Interbody Fusion.
PLIF is not even the full name of the surgery. The full name of the surgery is actually “posterior lumbar interbody fusion, rhizolysis, stereotactic pedicle screw fixation and posterolateral fusion.” Now that is a mouth full!
But at the end of the day, fancy names aside, it simply describes spinal fusion surgery whereby the surgeon simply approaches the spine from your back. There are in fact other ways to approach the spine including from your side or from your tummy. Have a read of the spinal fusion section here.
There are complex factors dictating why a spinal fusion should be performed from the back in one patient, from the side in another and from the front in another.
When I see you I will look at all these factors and work out what is best for you, your symptoms and your lifestyle. More importantly, I will work out if spinal fusion is necessary in the first place, and whether there is an alternative and smaller keyhole surgery that will sort out your spine, your pain and your quality of life.
PLIF surgery success rate Brisbane
How successful is PLIF surgery?
PLIF surgery is a successful type of spinal fusion surgery.
It is not like in the past where the surgeries were very big and invasive, with really long recovery times. Modern technology and techniques have vastly improved this operation, making the surgery smaller, and the recovery more rapid.
These days the single biggest factor determining success is the spine surgeon’s decision-making skills. PLIF works very well in patients who are suitable. In patients who are less than suitable the results are poor. It is up to the surgeon to work through all the complex factors to work out if you, your symptoms, your scan results and your lifestyle are suitable for this type of surgery. This process is critical.
Spinal surgeon Brisbane
When I see you I will take you through this process to work out if this is best for you or whether there is an alternative or smaller keyhole surgery that will sort out your spine, your pain and your quality of life.
The vast majority of patients that go through the modern PLIF position are very happy with the result. The goal of surgery is to improve your quality of life, whether that is to be pain-free, back on the golf course, or in the gym, or just be able to walk and move around freely.
Spinal surgeon Brisbane
I will consider all the important factors with you and determine what is best for you and the quality of life that you want to achieve.
PLIF surgery risks
Is it safe?
Yes, in experienced hands PLIF surgery is safe.
Computer-guided systems and 21st-century technology have made PLIF a safe and effective procedure.
With all this in mind the risks I will discuss with you are:
- The operation may not work: You may continue to have the symptoms despite PLIF surgery. Luckily, this is now quite rare.
- Despite all the engineering that goes into the spacers and screws, very rarely these screws and spacers may move, break or fail.
- Bleeding, however, this rarely causes a problem.
- Infection. This is rare in modern surgical practice:
- Antibiotics. When these were invented in the 1940s, surgery was utterly transformed.
- Proper skin care during and after surgery. Healthy skin is a vital barrier to infection: ‘If you look after the skin, the skin will look after you!’
- Shorter surgery. While there is no cut-off point, it is well recognised that the more efficient the surgery, and the less time is taken, the lower the risk.
- General risk of the anaesthetic like clots in the legs, clots in the lungs, urinary tract infections, skin injuries from being on a bed for a long time, and heart or kidney problems. Modern anaesthetic medicine makes many of these risks very low.
I am committed to achieving the best possible outcome for you and minimising the risks. This also means I will keep in touch with you whilst you recover.
There are 2 long term side effects I will talk to you about:
- Adjacent level disease
- Failure of fusion
The PLIF operation has been performed and perfected over many years, dating back to the 1950s. It is also one of the most common low back operations performed around the world today.
Have a read of the spinal fusion segment for a description. I will also describe it in detail for you when I see you.
You will have a general anaesthetic (be completely knocked out). You will lie on your belly on the operating table, so your back is facing the ceiling. The incision will be made in the lower back, right down the middle.
The length of this incision will depend on how many parts of your spine are being fused. The muscles under the incision are retracted to either side to uncover the underlying bones at the back of the spine. These are typically between 5-7cm under the skin surface, so quite a way down to get to the bone.
The next step involves the screws being inserted into the bone. The screws actually go into bone that sides towards the front of the spine. I will show you on a model exactly how this works when I see you. Computer guided navigation is used, a bit like a satellite GPS to safely guide the screws into position without touching anything other than bone. The length of these screws are typically between 3-5 cm and often 6-7mm in diameter, so surprisingly large given the overall size of the spinal bones. But despite this they usually sit very snug into the spinal bones and provide a lot of strength to the final construct.
This bone at the back of the spine that was uncovered at the start of the operation is then completely removed, to uncover the spinal nerves hiding underneath. This sounds a bit dramatic, but it is quite a common thing to do. It allows excellent access to the nerves, which is vital to allow the surgeon to then free up the nerves under direct vision by removing excess arthritic tissue. It also gives the surgeon direct access to the spinal disc. The nerves sit draped over the disc and so the surgeon exposes the disc by gently retracting these nerves off the disc. They usually move out of the way fairly easily. Once the nerves are safely out of the way, the docs is then opened up and all the contents so the disc completely removed. From here a spacer is placed in the now empty disc space and then the screws are connected all together by rods and everything is locked in place.
The posterior approach means going through muscles in your back, and this is what causes most of the pain. With adequate pain relief, you will be reasonably comfortable.
PLIF surgery alternatives
Are there any other good options?
There are 2-3 options available for any one case, differing in the pros and cons. I will present these to you.
What happens if I don't have PLIF surgery?
This is always an option. I will explain to you what this would look like for your symptoms and quality of life moving forward so you can make an informed decision.
PLIF recovery time
What can and can't I do afterwards?
PLIF recovery time really depends on your level of general health before surgery and how many parts of your spine are fused. On average, plan for about 1-4 days in hospital.
To get the best result you need to commit to a full recovery period. This doesn’t mean you will be resting all the time. As a matter of fact, I will encourage you to be as active as you can. I want you to get your confidence back as soon as possible, and you will be surprised how much you are allowed to do straight after the PLIF procedure.
Spinal surgeon Brisbane
I always say to my patients: Recovery after surgery is like compound interest; if you do the time, you’ll get the best result. If you shortchange yourself and bail out early you will miss out on significant benefits long term.
The scar in this part of the back actually heals up quite nicely. It will never disappear but often it is hard to see after a few months.
Often yes, and I arrange to see you in a week after your PLIF surgery to remove these.
I recommend a minimum of 2 weeks off work to get your confidence back and feel comfortable.
Physiotherapy has a very important role post-surgery. It helps reduce the muscle soreness and stiffness from the operation.
Spinal surgeon Brisbane
What else do I need to know?
If you would like me to assess your condition please contact my team to book an appointment.
Ready to make an appointment?
Ramsay Specialist Centre
Suite 325
Newdegate St
Greenslopes QLD 4120
