PLIF (Posterior Lumbar Interbody Fusion) Surgery

What is PLIF surgery?

Posterior lumbar interbody fusion (PLIF) surgery is a type of spinal fusion. PLIF is treatment for leg pain and lower back pain that happens when intervertebral disks — the soft round disks that separate your vertebrae — are damaged or wear out. These disks put pressure on your spinal nerve and cause leg or lower back pain.

In PLIF, spine surgeons remove the damaged disk and insert interbody spacers (devices) made of metal, plastic or bone. The devices are the same height as the damaged disk, so they fill the open space between your vertebrae.

Why is PLIF surgery done?

Healthcare providers typically use PLIF to treat:

• Degenerative disk disease.
• Spondylolisthesis.
• Spinal conditions like scoliosis.
• Recurring herniated disks.
• Spinal stenosis.

How common is PLIF surgery?

PLIF is a common treatment for chronic leg pain. It may be a treatment for lower back pain. Typically, PLIF and other lumbar surgery happen when pain management, physical therapy or other nonsurgical treatments don’t provide significant relief. Surgeons may do PLIF as open surgery — when surgeons make a single long incision through your skin — or as minimally invasive spine surgery.

What happens before PLIF surgery?

Before surgery, your care team will ask you questions to confirm you’re a good candidate for the operation. They’ll ask about your medical history, including any earlier back surgeries. Your team may:

• Ask if you take any prescription or over-the-counter medications or supplements (including herbal ones).
• Do blood tests and other tests to check your overall health.
• Encourage you to stop smoking or using tobacco if you use tobacco in any form. They may not offer you surgery if you use products that contain nicotine, including nicotine patches, gum with nicotine, electronic cigarettes (vapes). Studies show nicotine use makes it hard for your new bone grafts to grow and your surgical wound to heal. It also increases your risk of infection. 
• Discuss options for the bone graft material. In PLIF, spine surgeons remove damaged disks and use bone graft material to fill in the area where the damaged disk was located.
• Tell you what you need to do to prepare for surgery. 

Seven days before PLIF surgery

You should:

• Limit the number of beverages containing alcohol that you drink.
• Stop taking NSAIDs (nonsteroidal anti-inflammatory drugs) and anticoagulant (blood-thinning) drugs.
• Confirm how long you’ll need to stay in the hospital after surgery and plan accordingly.
• Arrange for someone to stay with you for the first day or two after you go home.

The day of PLIF surgery

You should:

• Stop eating or drinking anything eight to 12 hours before your surgery. If you must take certain medications, you can take a sip of water.
• Remember to bring medications for other conditions with you to the hospital.

At the hospital, you’ll meet with your anesthesiologist. They’ll explain the type of anesthesia you’ll receive and what to expect as you recover from anesthesia.

A healthcare provider will take you to the operating room. You’ll need to lie face down (prone) for surgery, and your care team will help you get into position before you receive anesthesia. 

What happens during PLIF surgery?

During PLIF, your spine surgeon will:

1. Make an incision (cut) in your lower back.
2. Separate your back muscles so they can access your spine, using a surgical tool to hold them in place.
3. Remove a section of bone known as lamina and pull back the membrane that surrounds your spinal cord (dura) so they can remove your damaged disk(s).
4. Prepare the bone graft material that will fill in the disk space. Bone graft material is like a thick paste or mortar. (Think of the layers of mortar in between bricks or stones on a wall.) 
5. Load the bone graft material into the spacer that will hold the material in place. The spacers act like a support frame that maintains the same height and space as the original disk. Your spine surgeon may use the term “cage” when talking about spacers.
6. Slide the spacer into place and add more bone graft around its sides.
7. Insert screws to hold the spacer in place.
8. Release your back muscles so they can fall into place, and then close your incision.

How long does PLIF surgery take?

In general, PLIF surgery takes two to three hours.

What happens after PLIF surgery?

Your care team will move you to a recovery area, where you’ll rest while you recover from anesthesia. Your recovery room team will regularly check your pulse, breathing and other vital signs and give you medication for pain.

You’ll move to another room in the hospital to continue recovering from your surgery. Your surgical team will check for complications like infections. You may need to spend a day or two in the hospital.

What are the advantages of PLIF surgery?

PLIF is one of several types of lumbar interbody fusion. Other types are anterior lumbar interbody fusion (ALIF), lateral lumbar interbody fusion and T-lumbar interbody fusion (TLIF).

If you’re considering spine fusion surgery, your spine surgeon will recommend the surgical choice that’s right for your situation. 

What are the complications of PLIF surgery?

Like most surgeries, PLIF complications may include risk of infection and excessive blood loss. Other potential complications include:

• Nerve damage.
• Damage to your back muscles.

How long will it take me to recover from PLIF surgery?

It could take a full year before you completely recover from surgery as your bone graft fills in the disk space and fuses your vertebrae. Your provider will give you detailed instructions on activities you can do and activities you should avoid as you recover.

How can I take care of myself after PLIF surgery?

It may be a relief not to have back pain. You may be eager to get back to your daily activities. Try to be patient and give your body time to recover. For example, you can (and should) take short walks every day. But it could be several weeks before you’re able to do things like bend, twist, lift objects or drive without pain. Here’s what you can expect:

First two to four weeks

You should avoid:

• Bending at your waist.
• Twisting your torso.
• Lifting anything heavy, even something as light as a gallon of milk.
• Driving, especially if you’re taking prescription pain medication that may slow your reactions.

Four to six weeks

You should avoid:

• Long car rides, even as a passenger. If you need to make a long trip by car, build in time to take breaks every few hours.
• Driving on your own even after you’ve stopped taking prescription pain medication and your provider says it’s OK for you to drive. You should arrange for someone to be with you because you can have sudden pain that may distract you and put you at risk of causing an accident.
• Bending and twisting.
• Lifting anything that weighs more than 10 pounds.

When should I see my healthcare provider?

You should contact your provider if you have:

• Fever that’s more than 103 degrees Fahrenheit (39.4 degrees Celsius).
• Chills.
• Your surgical site looks red or is tender to your touch.
• You have more pain than you expected.