Posterior Lumbar Interbody Fusion (PLIF) Animation

This video spotlights the lumbar (low back) section of the spine and animates how it is possible for an intervertebral disc to cause pain when it comes into contact with nearby nerve roots. This narrated animation also walks you through the steps a spine surgeon takes to treat this problem using a procedure called Posterior Lumbar Interbody Fusion (PLIF).

In between the five vertebrae in the low back are intervertebral discs. Along with other supporting structures (eg, ligaments), the vertebrae and discs help support the lower back and distribute loads and forces incurred at rest and during activity. The discs are also involved in movements that allow you to bend down to pet a puppy, or, if you are a gymnast, arch backward and touch the floor.

However, over the course of our lives, our discs, just like our eyesight for example, can naturally degenerate. Besides degenerative changes that gradually affect the spine, an unexpected traumatic accident may cause a disc to herniate or a spondylolisthesis to develop; either of which often lead to nerve compression resulting in low back and/or leg pain (eg, lumbar radiculopathy).
X-ray image highlighting spinal fusion with instrumentation.Posterior view of a patient’s lumbar spine after spinal instrumentation is implanted. Photo Source: 123RF.com.

Posterior Lumbar Interbody Fusion Procedure Notes

Posterior Lumbar Interbody Fusion (PLIF) is a surgical procedure that may be performed as a traditional open approach or utilizing techniques of minimally invasive spine surgery. PLIF is performed under general anesthesia in a hospital’s operating room or as an outpatient in an ambulatory spine center. The decision as to where PLIF is performed depends on many factors, including the patient’s general health status and complexity of the spine surgery (eg, number of levels). While the surgeon provides his recommendations, the patient is very involved in the surgical discussion and decision-making.

The purpose of PLIF is to decompress pinched nerves and stabilize the spine. The surgery involves an incision in the patient’s back (posterior approach). The length of the incision depends on the number of spinal levels to be surgically treated (eg, L3-L4, third and fourth lumbar vertebrae) and whether the procedure is open or minimally invasive. Nerve decompression involves removing bone and/or tissue pressing on spinal nerve roots. For each level surgically treated, part (ie, laminotomy) or all of the lamina (a bony plate) is removed from the back of the spinal column to help expose compressed spinal nerves and the intervertebral disc. Removal of the lamina is called a laminectomy. A facetectomy, or removal of part or all of the facet joints may be necessary to completely decompress pinched nerves. Thereafter, the intervertebral disc (or discs) are removed in a procedure called a discectomy.

Following the discectomy, two or more interbody devices, sometimes called interbody cages, are packed with bone graft and implanted into the empty disc space(s). Pedicle screws are embedded, and rods are attached to the screw fixations to provide immediate spinal stability. More bone graft is packed into the disc space and around the instrumentation. The soft tissues (eg, ligaments, muscles) are moved back into their normal places and the wound is closed using suture and/or staples.

Autograft, Allograft and BMP: Bone Graft Options

Autograft, allograft and bone morphogenic protein (BMP) are three types of bone graft materials.

  • Autograft is the patient’s own bone that is taken from the iliac crest of a hip bone. While autograft may be considered the best choice, it’s important to understand obtaining the patient’s own bone (called harvesting) requires a separate surgical procedure. Some patients have indicated the post-operative pain after the graft harvesting surgery was more painful that their spine procedure.
  • Allograft is donor bone acquired from a tissue bank.
  • BMP is a biological material containing factors that help stimulate new bone growth.

What to Expect After Posterior Lumbar Interbody Fusion

Bear in mind that no two patients are the same and post-operative recoveries vary. Some patients may need to be hospitalized for two to four days following PLIF. The patient may be discharged home after learning how to safely get in and out of bed, and walk and climb stairs.

The patient may be fitted for a lumbar brace to help support the spine, guard against excessive movement and assure a safe environment for bone fusion. Certain activities may be restricted or limited, such as sports, carrying and lifting while the fusion heals. Periodic x-rays are taken during the patient’s recovery to monitor progress of their spinal fusion.

Updated on: 02/15/19
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Anterior Lumbar Interbody Fusion (ALIF) Animation

ALIF video animation explains anterior lumbar interbody fusion, a type of spine surgery performed to treat spinal conditions that cause low back and leg pain, such as discogenic pain, degenerative disc disease or disc herniation.
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