Posterior Lumbar Interbody Fusion ("PLIF") ("lumbar fusion")

Why am I in pain?

The most likely cause of your pain is compression of the spinal nerves by a combination of overgrown ligaments, prolapsed disc and overgrown bony spurs within the spinal canal, which together cause compression of the lumbar nerve roots. The spinal cord is not being pinched – it ends approximately 2 inches above where your problem lies. Movement of one bone over the other causes terrible back pain, and this movement also further narrows the spinal canal and the exit foraminae where the nerve roots exit. This movement is known as “spondylolisthesis”.

Treatment Technique

You will drift off to sleep under general anaesthesia in a safe and controlled fashion by an anaesthetist. While you are under anaesthesia, you will not feel any pain, nor will you be aware of time passing. Having cleaned your lower back in a sterile fashion, an incision about 4 inches long in your lower back will allow us to push the muscles off of the bones surrounding the spinal nerve roots. Screws will be put into the bones above and below the unstable level/levels, with strong connecting rods between the screws. The nerves will be exposed through the removal of portions of the 5 bones of your lower back.

The ligaments causing the nerve compression and any bony spurs will also be removed. The disc at the unstable level will be fully removed and will be replaced with an implant to help fusion between the two bones. Once the nerves have been successfully decompressed, the wound will be stitched up, and the anaesthetist will allow you to wake up in a safe manner. The procedure itself will take approximately three hours, but your stay in the operating room environs may be a little longer than this. 


Everything you need to know

The primary benefit of PLIF is to provide relief of neurogenic claudication ("numb painful legs") pain, in patients who have failed more conservative treatment options.  A PLIF procedure fuses the bones together, stopping unwanted excess movement, and removes pressure off of the lumbar nerve roots. The reduction and fusion of the spondylolisthesis will relieve back pain caused by unwanted movement of the vertebrae. 

The main risks particularly associated this procedure are spinal fluid leak, infection, failure of your symptoms to improve, worsening of your symptoms, a recurrence of your symptoms, damage to the spinal nerves with resultant weakness of your leg muscles, a progression degeneration at other joint levels requiring further surgery, or damage to your bladder and bowel continence. A more extensive list of risks is detailed on the consent form.

The majority of patients with back and leg pain do experience significant pain relief. Nobody but you knows how much pain you're experiencing. If you've tried other treatments, and your pain is interfering with your life, then the decision is up to you.

Alternatives to PLIF/lumbar fusion would include physiotherapy, nerve root injections and epidural injections by a pain management specialist. These are successful in alleviating the pain temporarily in approximately 50% of cases. Whilst you can walk, perhaps, for 15 minutes now without stopping, next year you may find you can only walk for 10 minutes, and the year after that, 5 minutes. In other words, this condition is progressive in the vast majority of cases. Decompressing the nerve roots without fusing the bones can in fact worsen the slipping/"spondylolisthesis", resulting in a worsening of your back pain.

You will be admitted to the hospital on the morning of surgery, and will be discharged home within 7 days. You will need to get somebody to drive you home from the hospital on the day of discharge. You will need somebody to help you around the house once you're discharged from the hospital. Some people stay with their sons, daughters, or relatives; others prefer to stay temporarily at a nursing home of their choosing. This ought to be arranged by you or your family before you undergo surgery. 

The stitches used to close the wound are dissolvable, but you may need to get superficial skin-clips removed 2 weeks later by your GP/Practice-nurse. You will have a stiff sore back for the first 4 weeks after this procedure, but by the time you are reviewed in the clinic this should be improving. Typically an improvement in your leg or foot pain will be the first benefit you will notice after this procedure, next an improvement in any "pins-and-needles", and lastly an improvement in any numbness (this may take a number of months or may in fact persist permanently). Once your back has fused properly your back pain ought to be much improved. The scar will fade to a dull white mark over the next 12 months.

Desk-workers are advised to refrain from returning to full-employment for 2 months. Housewives (and house-husbands!) need a similar period of time to recover also. People with flexible work hours, and those who can complete their duties whilst standing upright may return to work after 6 weeks. People who return to work too early have been shown to experience a greater degree of long-term back pain.

Patients can usually return to jogging in approximately 3 months, though each case will need to be judged on it's individual merits, taking factors such as the athlete's age, particular athletic activity, and body habitus into account.

You will be reviewed in the clinic after 6 weeks, and again 3 months later to confirm that your recovery has proceeded satisfactorily, and that further imaging tests or therapies are not required. You will have been given a regime of low-back muscle exercises by the physiotherapy department - it is important that these exercises become as regular a part of your daily routine as brushing your teeth!

Should you experience any unusual symptoms or signs either prior to your surgery or during your subsequent recovery period you must contact our office line immediately. Should that not be possible, we would advise you to seek immediate medical advice from a registered medical practitioner. Urinary or faecal incontinence, urinary retention, constipation, difficulty breathing or completing sentences, new-onset numbness or leg weakness, a painful calf or thigh (especially if red or swollen) are all reasons to call us immediately, or to go to your local hospital emergency department.

Always tell your surgeon if you are taking Aspirin, Disprin, Plavix (Clopidrogel), Warfarin,Dipyridamole (Persantine), Asasantin, Aggrenox or if your medical condition has changed in any respect in the period of time prior to your procedure.

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