A
posterior lumbar interbody fusion (PLIF) is a type of spine surgery
that can be performed in a minimally invasive way. Posterior lumbar
interbody fusion (PLIF) is a type of spine surgery that involves
approaching the spine from the back (posterior) of the body to place
bone graft material between two adjacent vertebrae (interbody) to
promote bone growth that joins together, or "fuses," the two structures
(fusion). The bone graft material acts as a bridge, or scaffold, on
which new bone can grow. The ultimate goal of the procedure is to
restore spinal stability.
Today,
a PLIF may be performed using minimally invasive spine surgery, which
allows the surgeon to use small incisions and gently separate the
muscles surrounding the spine rather than cutting them. Traditional,
open spine surgery involves cutting or stripping the muscles from the
spine. A minimally invasive approach preserves the surrounding muscular
and vascular function, minimizes scarring, hastens recovery and
decreases hospitalization stay.
How is it done?
PLIF surgery aims at achieving spinal stability through bony fusion by two ways:
The Open PLIF is the traditional technique which is performed using
general anesthesia. The patient is made to lie down on his front side on
the table with the low back exposed. A 3-6 inch long incision is made
on the skin overlying the affected vertebrae. The skin and the fascia
are cut open. The underlying muscles are retracted and the affected
vertebrae are identified. Fluoroscopic X-ray is used to confirm the
exact location of the affected vertebrae. Then a complete laminectomy
(removal of the lamina of the vertebrae) followed by bilateral
foraminotomy (enlargement of the foramen by removing the bony spurs)
and/or discectomy (removal of offending disc) are performed.
This
relieves the compression off the spinal nerves, allowing them to come to
their normal size and shape. The area is checked for any remaining bony
outgrowth or disc fragments that may compress the nerves. Autogenic
bone grafts or Metal or plastic implants are fitted in the empty disc
space for initiating bone growth. Finally, pedicle screws are placed
into the upper and lower vertebrae and connected with rods or plates.
New bone is allowed to grow over these rods, helping to bridge the
adjacent vertebrae and achieving interbody fusion. The total surgery
time is approximately 3 to 6 hours, depending on the number of spinal
levels involved.
The other method is the Minimally Invasive PLIF procedure which is performed using x-ray guidance:
2.5-cm incisions are made on either side of the lower back. The muscles
are gradually dilated and tubular retractors inserted to allow access
to the affected area of the lumbar spine. The lamina is removed to allow
visualization of the nerve roots. The offending disc material is
removed from the spine and replaced with a bone graft and structural
support from a cage made of bone, titanium, carbon-fiber, or a polymer,
followed by placement of rod and screws. The tubular retractors are
removed, allowing the dilated muscles to come back together, and the
incisions are closed. This procedure typically takes about 3 to 3 ½
hours to perform. There was less blood loss, tissue trauma, operative
time, and quick recovery in this procedure as compared to the
traditional one
Post-Operative Care after PLIF
Most
patients are usually able to go home 3-5 days after surgery. Before
patients go home, physical therapists and occupational therapists work
with patients and instruct them on proper techniques of getting in and
out of bed and walking independently. Patients are instructed to avoid
bending at the waist, lifting (more than five pounds), and twisting in
the early postoperative period (first 2-4 weeks) to avoid a strain
injury. Patients can gradually begin to bend, twist, and lift after 4-6
weeks as the pain subsides and the back muscles get stronger.
Recovery from PLIF
Rehabilitation after PLIF can be a slow process. Many surgeons prescribe
outpatient physical therapy beginning a minimum of six weeks after
surgery. This delay is needed to make sure the graft has time to begin
to fuse. You will probably need to attend therapy sessions for two to
three months. You should expect full recovery to take up to eight
months.
Most Advanced PLIF Surgery at MyMedOpinion.com Affiliated World Best Hospitals in India
MyMedOpinion.com affiliated world best hospitals in India are a benchmark in
comprehensive spine care for such complex and sensitive surgeries. They
provide the best medical services in India. The procedure is performed
by highly qualified orthopedic or neurosurgeons who have trained for
decades at world’s best spine hospitals and have an excellent track
record of successful outcomes.
The hospitals have a state of art diagnostic
centre with high end imaging equipment like 1.5 Tesla MRI, 256 slice CT
Scan, digital X-rays and EEG and EMG facilities. The operation theatres
have Laminar flow infection free environment and most advanced equipment
like Computer Navigation endoscope, video monitoring, special biting
and grasping instruments, fluoroscopic X-rays and physiotherapy services.
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