Lumbar fusion surgery is designed to create solid bone between the adjoining vertebra, eliminating any movement between the bones. The goal of the surgery is to reduce pain and nerve irritation. Posterior lumbar interbody fusion (PLIF) removes the lumbar disc and insert a cage filled with bone into the space left behind.
The most common reason for performing PLIF is that the patient’s symptoms such as leg pain, or leg numbness or weakness have not improved with nonsurgical treatment.
Sometimes, symptoms are due to degenerative process in the back where the facet joints enlarge, the disc bulges, and the yellow ligament thickens. This reduces the space around the nerves to the legs and causes your symptoms.
In general, this is treated with a laminectomy, but if the spine appears unstable after the surgery, a fusion is recommended along with the laminectomy.
BEFORE THE PROCEDURE
You should advise your doctor if any of the following apply:
- You have blood clotting problems
- You have any health issues
- You are taking blood thinning medication
- You have improved from the time you decided to have surgery
- You have drug allergy or other allergies
DURING THE PROCEDURE
The operation is performed with you lying on your stomach. You are given a general anesthetic, and the area where the incision is to be made is prepared with antiseptic.
An incision is made in the patient’s back to allow the surgeon access to the spine. The bone of the lamina and part of the facet joint may be removed. Then the ligament is removed to expose the dura and the compressed nerves. All of the nerves are decompressed.
Two screws are inserted to each vertebra and their positions are verified by x-ray. The disc is removed and the cage of titanium or carbon fiber is inserted. This is repeated on the other side. Once everything is aligned, the rods are placed between the screws on each side. Bone is taken from part of the hip and placed along the side to help the spine fuse. Special attention is given to the nerves to make sure all pressure is removed. The openings under the facet joints that let nerves out of the spine are checked and opened if necessary. The wound is closed.
AFTER THE PROCEDURE
After the surgery, you will be taken to the recovery area and then to your room. The nursing staff will continually check your blood pressure, pulse, and leg strength for any changes that indicate a complication. Pain medication will be administered intravenously. A catheter may be required.
After your first walk the next day, the IV will be removed and you will be put on oral pain medication. Over the next two or three days, you will be able to get around as normal. You can expect to be in the hospital five to nine days. On discharge, you will be able to perform most tasks of daily living (e.g., showering, dressing).
It is important to walk as much as possible. You will need to wear a lumbar brace for three months. You will not be able to drive for at least six weeks. You should avoid heavy lifting, twisting, and prolonged sitting. You should be able to return to work at about two months, subject to your doctor’s instructions. Extreme labor is usually not recommended.
Approximately six weeks after the surgery, you will see the doctor. You will have regular follow-up x-rays. The aim of the surgery is to get you as close to normal as possible. The degree to which you will get back to normal depends on the reason for the surgery. In general, if you had weakness or pain this should improve. If you had numbness, this may not improve. You have a bad back and it is unlikely that you will be perfect after the surgery.
Most people do have ongoing back discomfort; this will vary from person to person. This may improve with anti-inflammatory medication.
Source: Prairie Spine and Pain Institute, Dr. Richard A. Kube II, MD.