Quick Facts
Possible Symptoms
- Leg pain, numbness, and/or weakness
- Back pain, especially with movement
- Bowel or bladder incontinence
Typical X-Ray Findings
- Spondylolisthesis, or slippage of one vertebral body upon another (MRI, CT myelogram).
- Disc and endplate changes suggesting excess “wear and tear” (MRI, CT myelogram).
- Excess movement of one vertebral body upon another when bending forward or backward (Flexion and extension x-rays)
Average Procedure Time
- 4 hours
Average Recovery Time
- Home in 2-4 days
- Off work 6-8 weeks, depending on duties
Postperative Limitations
- No bending, twisting, lifting, or strenuous exercises (8 weeks)
- No driving while on narcotics
The Procedure
A PLIF, or Posterior Lumbar Interbody Fusion, involves removing bone bilaterally, retracting the nerve roots on each side, removing a significant portion of the disk, and then placing a small, bulleted cage into the disk space on each side. The medical literature supports “backing up” a PLIF with posterolateral lumbar fusion and minimally invasive instrumentation with screws and rods placed from the same incision, so this is done in almost all cases.
Newer technology has allowed the placement of even larger cages through a single approach, so the PLIF has largely been supplanted by the newer TLIF, XLIF, and ALIF procedures. Nonetheless, PLIFs are still useful in situations in which the nerve roots must be directly decompressed on both sides, or in patients who are a high risk for failed fusion but who would not tolerate an anterior or lateral approach.
The prinicpal disadvantage of a PLIF is that nerve roots must be exposed bilaterally, and must occasionally be retracted a great deal in order to place the cages.