Posterior Lumbar Interbody Fusion & Transforaminal Lumbar Interbody Fusion

Why Choose PLIF or TLIF?

These procedures are commonly chosen for their effectiveness in stabilizing the spine and relieving symptoms like chronic back pain, leg pain (sciatica), and nerve compression. They are typically considered when conservative treatments (physical therapy or medications) have failed. The choice between PLIF and TLIF depends on the specific condition, patient anatomy, and other considerations evaluated during your preoperative workup.

What Happens During PLIF & TLIF Surgery?

Preparation

Hospital Admission: You will be admitted on the day of surgery. Fasting is required per your anaesthetist's instructions.
Anaesthesia: The procedure is performed under general anaesthesia, ensuring you are asleep and pain-free.

Surgical Approach

Patient Positioning: You will be positioned face down (prone) on the operating table to allow access to the lower back.
Incision: A midline incision is made in the lower back to expose the lumbar spine. Muscles and soft tissues are carefully retracted to visualize the vertebrae and intervertebral discs.

Disc Removal and Preparation for Fusion

PLIF Approach: The disc space is accessed by retracting nerve roots on both sides. The damaged disc is removed from the back.
TLIF Approach: The disc space is accessed unilaterally (from one side), which minimizes nerve retraction and risk of nerve injury. The damaged disc is then removed.
Preparation for Fusion: The disc space is thoroughly cleaned, and the bony surfaces are prepared for fusion.

Insertion of the Interbody Cage and Bone Graft

Interbody Cage Placement: A cage filled with bone graft material (autograft, allograft, or synthetic) is inserted into the disc space to restore disc height, align the spine, and promote fusion. In PLIF, two cages are typically placed bilaterally, while in TLIF, one cage is inserted unilaterally.
X-ray Verification: Intraoperative X-rays confirm proper placement of the cage and correct spinal alignment.

Pedicle Screw and Rod Placement

Stabilization: Pedicle screws and rods are inserted into the vertebrae using computer-assisted navigation. These implants stabilize the spine and support the fusion process.

Closure

Once the implants are in place and alignment is confirmed, the incision is closed with sutures, and a sterile dressing is applied to protect the wound.

Postoperative Care and Recovery

Hospital Stay: Most patients remain in the hospital for 2-4 days depending on the extent of surgery and recovery.
Pain Management: Medications are used to manage pain, and early mobilization is encouraged to reduce risks such as blood clots and pneumonia.
Rehabilitation: A tailored physiotherapy program is initiated shortly after surgery to restore strength, flexibility, and proper body mechanics.
Activity Restrictions: Patients should avoid heavy lifting, bending, and twisting for at least 3 months, with a gradual return to normal activities under guidance.
Follow-Up: Regular follow-up appointments are scheduled (typically at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months) to monitor healing and implant stability.

Risks and Complications

Infection: There is a risk of infection at the surgical site.
Bleeding: Excessive bleeding during or after surgery may occur.
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, which could require additional surgery.
Adjacent Segment Disease: Increased stress on the segments adjacent to the fused area may lead to future degeneration.
Groin/Thigh Pain: Occasional groin or thigh pain may occur due to retraction of the psoas muscle, typically resolving within 3-4 weeks.

Patient-Reported Outcomes and Results

Most patients experience significant improvements in pain and function following lumbar fusion surgery. To learn more about Prof Aaron Buckland’s patient-reported outcomes for various lumbar fusion procedures, please click here.