Posterior Lumbar Interbody Fusion (PLIF)

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Indications for Spinal Surgery

One of the most difficult jobs of a spinal surgeon is deciding when surgical intervention is appropriate. There are five basic reasons to offer surgical treatment to patients with spinal disorders.
Surgeons reviewing a patient x-ray.There are five basic reasons to offer surgical treatment to patients with spinal disorders. Photo Source:

  1. Neurologic dysfunction (pinched nerve)
  2. Structural instability
  3. Pathologic lesions (such as tumor or infection)
  4. Deformity or abnormal alignment
  5. Pain

Placing patients in one or more of the five categories allows the spinal surgeon to organize his/her thoughts. In general, non-operative treatments should be considered first prior to surgical intervention. All of the groups can be managed non-operatively or operatively. Once all conservative measures have been exhausted over a reasonable period of time, then surgical intervention may be appropriate. In general, minimally invasive endoscopic techniques are considered prior to more extensive reconstructive procedures.

Indications for PLIF What is a PLIF?

A spinal fusion that is performed from the back, by placing bone or cages within the disc space. Indications for performing a posterior lumbar interbody fusion (PLIF) can be extrapolated from the five basic indications for surgery of the spine patient. Deformity: A PLIF should be considered as an option in the surgical treatment of a painful motion segment adjacent to a long scoliosis fusion.


In the case of spondylolisthesis, grades I and II, PLIF can be considered. For grades III and IV, PLIF is usually indicated only as an adjunctive surgical intervention when partial or complete reduction of the slip can be achieved. Additionally, it may also be used as an adjunct to the surgical treatment of certain types of fractures or dislocations.

Neural compression

A PLIF may be used as a surgical intervention in certain situations with neural compromise such as recurrent disc herniation with radiculopathy, neurogenic claudication, spinal stenosis or cauda equina syndrome, especially if low back pain is also a predominant symptom. One must realize however, that the primary surgical procedure for neural compression is decompression by laminectomy, laminotomy, foraminotomy, or discectomy.

Pathologic lesions 

A PLIF is often not needed in tumor cases and only occasionally used in infection.


This is the most common indication for a PLIF. It can be used in the surgical treatment of symptomatic spondylosis and/or symptomatic degenerative disc disease. To demonstrate the painful, degenerative level(s), MRI in conjunction with confirmatory discography is recommended.

Additionally, PLIF can be used for the treatment of pseudoarthrosis, which is a non-union or incomplete spinal fusion.

Commentary by: Curtis A. Dickman, MD

Posterior lumbar Interbody Fusion (PLIF) is a surgical technique that allows fusion across two adjacent vertebrae by inserting bone grafts, titanium threaded cages, bone dowels, or carbon fiber spacers filled with bone graft into the disc space. All PLIF techniques require removal of the posterior bone of the spinal canal (laminectomy), retraction of the nerves, and removal of the disc material from within the disc space. The bone grafts and spacing devices are used to heal a bony bridge (fuse) the two adjacent vertebral bodies. 
PLIF is a valuable way of achieving a spinal fusion. If spinal instability is present (ie, spondylolisthesis or slippage of the vertebrae) then the PLIF should be performed with spina stabilizing instrumentation such as pedicle screws or hooks and rods to immobilize the loose vertebrae.                        

Other options to achieve a lumbar fusion include Anterior Lumbar Interbody Fusion (ALIF), posterior facet fusion, or posterior intertransverse fusion (grafts between the transverse processes).

Updated on: 02/26/19
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Curtis A. Dickman, MD
Barrow Neurological Institute
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