Posterior Lumbar Interbody Fusion (PLIF) and Transforaminal Lumbar Interbody Fusion (TLIF) are two surgical techniques used to treat various conditions of the lumbar spine, such as degenerative disc disease, spondylolisthesis, and spinal stenosis. Both procedures involve removing a damaged disc and fusing the adjacent vertebrae to stabilize the spine and alleviate pain, but they differ in the surgical approach used to access the spine.

Why Choose PLIF or TLIF?

PLIF and TLIF are commonly chosen for their effectiveness in stabilizing the spine and relieving symptoms such as chronic back pain, leg pain (sciatica), and nerve compression. These procedures are often preferred when other conservative treatments, such as physical therapy or medications, have not provided sufficient relief. The choice between PLIF and TLIF, or other fusion methods of the lumbar spine depends on the specific condition, patient anatomy, and other considerations assessed by A/Prof Buckland in your preoperative workup.

What Happens During PLIF & TLIF Surgery?

Preparation

• Hospital Admission: You will be admitted to the hospital on the day of surgery. Fasting is required before the procedure, as directed by your anaesthetist.
• Anaesthesia: The surgery is performed under general anaesthesia, ensuring you are asleep and pain-free during the procedure.

Surgical Approach

• Patient Positioning: You will be positioned face down (prone) on the operating table to allow access to the back of your spine.
• Incision: A midline incision is made in the lower back to expose the lumbar spine. The muscles and tissues surrounding the spine are carefully retracted to provide a clear view of the vertebrae and intervertebral discs.

Disc Removal and Preparation for Fusion

• PLIF Approach: In PLIF, the disc space is accessed by retracting the nerve roots on both sides of the spine. The damaged disc is removed from the back, and the space is prepared for fusion.
• TLIF Approach: In TLIF, the disc space is accessed from one side of the spine (unilateral approach), which minimizes retraction of the nerve roots and reduces the risk of nerve damage. The damaged disc is removed, and the space is prepared for fusion.

Insertion of the Interbody Cage and Bone Graft

• Interbody Cage Placement: A cage (spacer) filled with bone graft material (either from your body, a donor, or synthetic) is inserted into the empty disc space. This cage helps to restore disc height, align the spine, and promote fusion between the vertebrae. In a PLIF, two cages are placed (bilaterally) into the disc, whereas in a TLIF, only one cage is inserted (unilateral).
• X-ray Verification: Intraoperative X-rays are taken to confirm the correct placement of the cage and proper alignment of the spine.

Pedicle Screw and Rod Placement

• Stabilization: Pedicle screws and rods are inserted into the vertebrae to stabilize the spine and support the fusion process. These implants are typically made of titanium or other durable materials and are positioned to maintain the alignment and stability of the spine during healing.

Closure

• The surgical site is carefully closed with sutures, and a sterile dressing is applied to protect the wound. The muscles and tissues are repositioned to minimize the risk of complications.

Postoperative Care and Recovery

Hospital Stay

Most patients stay in the hospital for 2-4 days following PLIF or TLIF surgery, depending on the extent of the surgery and the recovery progress. A drain is often placed to protect the wound and will be removed 1-2 days after the procedure in most cases.

Pain Management

• Pain is managed with medications, and early mobilization is encouraged to reduce the risk of complications such as blood clots or pneumonia. The posterior approach may result in more postoperative discomfort due to the retraction of back muscles, but this can be effectively managed with proper pain control measures.

Rehabilitation

Physiotherapy: A tailored rehabilitation program will be initiated shortly after surgery, focusing on restoring strength, flexibility, and proper body mechanics. Physical therapy plays a crucial role in achieving the best possible outcome.

Activity Restrictions: Patients should avoid heavy lifting, bending, and twisting for at least 3 months after surgery. Gradual return to normal activities will be guided by A/Prof Buckland’s team.

Follow-up

• Follow-up appointments will be scheduled typically at 2 weeks, 6 weeks, 3 Months, 6 Months and 12 Months after surgery. X-rays are obtained all of these visits other than 2 weeks post-surgery.

Risks and Complications

As with any surgery, there are potential risks, including:

• Infection: There is a risk of infection at the surgical site.
• Bleeding: Excessive bleeding during or after surgery is possible, particularly due to the proximity of blood vessels.
• Nerve Injury: There is a risk of injury to the spinal nerves, which could result in weakness, numbness, or other neurological symptoms.
• Non-Union: In some cases, the bones may not fuse as expected, potentially requiring additional surgery.
• Adjacent Segment Disease: The segments above and below the fused area may experience increased stress, leading to future degeneration.

Patient-Reported Outcomes and Results

Lumbar Fusion Surgery significantly improves function and pain in the majority of patients. Learn more about A/Prof Buckland’s patient-reported outcomes below.