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Posterior and Transforaminal Lumbar Interbody Fusion (PLIF/TLIF)

INDICATIONS

These operations are performed for a combination of symptoms that have not responded to non-operative treatments. The symptoms include:

  • Spondylolisthesis, where the vertebrae above slips forward in relation to the vertebrae below
  • Recurrent disc prolapse causing leg and back pain
  • Symptomatic degenerative disc disease and discogenic pain
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ABOUT THE OPERATION

The operation is performed under general anaesthetic. You will have a urinary catheter placed, and will be positioned face down on a specialised operating table. An xray is taken to confirm the position of the incision, and then the spinal muscles are elevated off the back of the spine. Using either computer navigation or robotic guidance, pedicle screws are placed into the intended part of the vertebrae and are then checked using xray.

A thorough decompression is then performed of the area that is causing the compression, and this typically involves removing both facet joints. The nerves are checked to ensure they are not compressed, and then the disc is removed fully. A cage is placed into the disc space, and is packed with bone graft to help the two bones fuse together.

Curved rods are placed into the previously placed screws, and attention is placed to ensure that the correct alignment is achieved. Final xrays are taken to confirm this. Bone graft is placed into the posterior aspect of the spine to help further fusion.

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AFTER THE OPERATION

You will wake up in the recovery room being cared for by the nursing staff. Once you are safe, you will be taken to the surgical ward for ongoing care.

You will be checked regularly and you will often have pain medication running through a pump to help keep you comfortable. You will be helped to walk the day after surgery by the physiotherapy staff, and then will progress to independent walking when safe. Once you have been cleared medically, as well as from the physiotherapists, you will be allowed to be discharged to home. Some people need extra help and will go to an inpatient rehabilitation facility for a period of time.

You will be allowed to walk, but not drive for 6 weeks. Your walking distance will increase during your recovery perido, but generally start small and build up as you are able to. You should avoid any lifting more than 5 kilograms, and should try to avoid twisting/bending as much as possible until you have been given clearance by Dr Anderson.

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RISKS OF THE OPERATION

This operation caries general risks as with any surgery, such as bleeding, infection, medical complications such as heart attack, stroke, blood clots and pneumonia. More specific risks to this procedure include:

  • Malpositioned implants – this is a rare occurrence due to the use of computer navigation and robotics, but can still occur. Dr Anderson is highly trained in the implantation of spinal devices, and uses xray and/or CT checks to improve safety even further
  • Nerve injury – generally caused by traction of the nerve during placement of the intervertebral cage. This can range from mild paraesthesia to complete nerve palsy and the affected region will depend on the nerve involved
  • CSF leakage – if a tear of the lining of the nerves occurs, this will be repaired during the operation. Rarely the fluid (CSF) will continue to leak after the operation, and will need to be surgically closed again
  • Non-union – this is higher in patients who are actively smoking, have poorly controlled diabetes, or take medications for anti-inflammatory conditions.

Dr Anderson will thoroughly discuss the potential complications with you during your appointment. If you have any specific questions, you will be given time to fully address these.