Minimally Invasive Posterior Lumbar Interbody Fusion (PLIF)

Minimally invasive posterior lumbar interbody fusion (PLIF) is a minimally invasive surgical technique that is performed in patients with refractory mechanical low back and radicular pain associated with spondylolisthesis, degenerative disc disease, and recurrent disc herniation. The procedure is performed from the back (posterior) with the patient on his or her stomach.

Using x-ray guidance, two 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 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 rod and screw placement. 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.

Outcome
In a study of 31 patients who underwent the MIS PLIF surgery, there was less blood loss, tissue trauma and operative time, and quick recovery. In two patients, the pedicle screws were not ideally positioned, but there was no nerve root irritation or fixation failure and thus no revision was required. The overall short-term outcomes were excellent.

American Association of Neurological Surgeons
Neurosurgerytoday.org
Minimally Invasive Spine Surgery, January 2009

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