Posterior Lumbar Interbody Fusion
What is a Posterior Fusion / PLIF?
Contrary to popular belief, your spine isn’t a straight line. When viewed from the side, your spine contains a series of gentle curves. Your lower back, or lumbar spine, slopes inward. And, your upper back, or thoracic spine, arcs slightly forward. However, when viewed from the front, a healthy spine does appear straight. In fact, if your spine curves even 10 degrees from the center and to the side, you have scoliosis.
If you have more than 40 degrees of scoliosis, kyphosis, or lordosis, then serious problems can arise. You may experience:
- Outward signs of spinal deformity
- Severe neck, back, or leg pain
- Trouble with walking or completing your day-to-day tasks
- Chin on chest syndrome
- Ruptured discs from extreme pressure
- Issues with breathing or heart function
- Loss of bowel or bladder control
If this sounds like you, a PLIF can greatly improve your quality of life.
What is Removed During a Posterior Fusion / PLIF Procedure?
As the name suggests, your surgeon will perform a Posterior Fusion / PLIF from the back, or posterior side. Although the “L” in PLIF stands for lumbar, your doctor can perform this procedure on either your lower back or the thoracic spine. In this case, the procedure is simply known as a posterior fusion.
Prior to spine surgery, your physician will take MRIs and CT scans of your back to gauge the implant size. Your surgeon will then access your spine from the back, using a 3 to 6-inch incision. Metal retractors will gently hold your muscles to the side, exposing your vertebrae to the surgeon. If your surgeon wishes to use pedicle screws, then he or she will insert them now. Specifically, screws will be placed above and below the fusion site.
Now, the Posterior Fusion / PLIF surgery can begin. Your surgeon will remove your:
- Lamina: The bony sheath that surrounds your spinal canal and protects your spinal cord and spinal nerve roots.
- Facet Joints: The hinge where two vertebrae meet. (Your surgeon will only trim the facet joints if you have pinched nerves from scoliosis, kyphosis, or lordosis.)
- Damaged Discs: The rubbery cushions between each set of vertebrae. (Your surgeon will only remove discs that are bulging or have herniated from your condition. If your doctor removes a disc, then an implant will bridge the disc space.)
Next, your surgeon will attach metal rods to the pedicle screws (if needed). These rods allow your doctor to realign the spine, adjusting any abnormal curvature and aligning any slipped vertebrae.
How Does the Fusion Process Work During a Posterior Fusion / PLIF?
With the rods in place, your doctor will insert a bone graft into the interbody space. (The interbody space is simply the gap that exists between two vertebrae.) Your doctor may take this bone graft material from the patient’s hip (known as an autograft) or from a donor bank (known as an allograft).
In addition, your surgeon may choose to use a cage to deliver the bone graft into the interbody space. As new bone tissue develops, it will grow through the “bars” of the cage to fuse with your vertebrae.
If you have osteoporosis, then your doctor may add a special protein to your bone graft. This protein will make any weakened bones even stronger.
With the right amount of time, your vertebrae will fuse together. This creates a spine that curves just right amount and has permanent stability.
What are the Advantages of Posterior Fusion / PLIF?
Certain types of spinal deformity respond best to a Posterior Fusion / PLIF, or posterior approach. The best approach for you will depend greatly on the nature of your curvature. However, when a Posterior / PLIF is combined with an ALIF (or anterior/frontal fusion), the success rates are off the charts. Aside from delivering effective relief, you can expect to enjoy the following benefits:
- Minimally Invasive: Advances in surgical techniques and materials have made this procedure minimally invasive for some patients. This means less scarring, smaller incision sizes, and less blood loss.
- Less Post-Operative Pain: Less trauma to the back leads to less pain during the healing period. This also translates to a speedier recovery. You can get back to your day-to-day activities in no time.
- Deformity & Pain Correction: A Posterior Fusion / PLIF can reverse the visible signs of spinal deformities and restore heart and lung function. In addition, your surgeon can easily remove damaged discs during the process and decompress pinched nerves.
- Lasting Stability: Moreover, fusion materials, including hooks, rods, screws, and grafts, ensure that your spine is stable for years to come.
Do you need a Posterior Fusion / PLIF? Contact Dr. Jason Lowenstein, award-winning scoliosis surgeon, to reclaim your life from spinal deformity!
Do I Qualify for a Posterior Fusion or Posterior Lumbar Interbody Fusion?
You may need a Posterior Fusion / PLIF if you have:
- Scoliosis: If you have more than 45 degrees of scoliosis after reaching bone maturity; or if your pediatric scoliosis (>45 degrees) did not respond to scoliosis bracing.
- Kyphosis: If you have degenerative kyphosis from degenerative disc disease or more than 45 degrees of kyphosis. (Osteotomies are common forms of correction for kyphosis. A PLIF is often part II of this surgery.)
- Lordosis: If you have more than 45 degrees of lordosis in your lower back.
- Spondylolisthesis: If you have >5o% forward slippage with a slipped vertebra.
However, not every patient will qualify for a Posterior Fusion / PLIF. If you smoke cigarettes; have a spinal infection or tumor; or suffer from allergies to the surgical materials used during the procedure, then other treatments may work better for you.
To find out if you qualify for a Posterior Fusion / PLIF, contact Dr. Jason Lowenstein, MD today! Dr. Lowenstein is a board-certified, fellowship-trained spine surgeon, who has earned over a decade of surgical experience and recognition. He is widely regarded as an expert and innovator in the field of minimally invasive scoliosis surgery. To get the treatment you deserve, contact the Lowenstein team today!