POSTERIOR/TRANSFORAMINAL LUMBAR INTERBODY FUSION (PLIF/TLIF)
Posterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion are surgical procedures where the spine is accessed through the back. A “fusion” denotes the creation of one solid bone between two adjoining vertebrae which are normally separated by a shock-absorbing disc. The purpose of the surgery is to decrease back pain. When combined with a lumbar laminectomy, which involves releasing the compression on a spinal nerve or the spinal cord by widening the area, patients can have both relief from leg, buttock and back pain.
The Procedure
The procedure involves a low back incision through which the surgeon removes
the posterior bone of the spinal canal and retracts the spinal nerves. The disc material is
then removed and replaced with a spacer or cage. Typically, a PEEK
(polyetheretherketone) cage is used. Bone is placed in front of the cage, inside the cage,
as well as in the lateral gutters of the vertebrae. The bone graft used is a combination of
local bone removed during surgery, bone morphogenic protein (BMP), as well as bone
marrow taken from the pelvic bone (aka iliac crest). The spine is stabilized with
titanium screws, rods and sometimes a cross link. The incision is then closed with
absorbable sutures and dermabond. Average length of the surgery is 2 to 4 hours depending
on the number of levels fused.
Pre-operative testing and preparations
You will be advised, if possible, to donate at least 2 units of your own blood
approximately 1 month prior to your surgery date. We will provide you with the
information to schedule this appointment with the American Red Cross. Usually, only
one unit is donated at a time, so it may take you two to three visits to the blood bank to
acquire the necessary amount of blood. In some cases, family members with the same
blood type may donate instead, which is called directed donor blood. If for some
reason you or your family cannot donate blood, screened donor blood from the blood
bank may be used.
Prior to your surgery date, you will be required to undergo routine laboratory tests, EKG and a chest x-ray. If you are over 50 years of age or have any history of cardiac or pulmonary problems, you will also be required to have a clearance by a cardiologist or pulmonologist, respectively. You will also be given information on what medications, both prescription and over the counter, that need to be discontinued preoperatively as many can interfere with wound healing and bleeding time.
What to expect in the hospital post-operatively
You will wake up in the recovery room after the operation is over. During this
time you may be disoriented and tired, which is the normal effects of the anesthesia
wearing off. Once stable, you will be taken to your room where you may be greeted by
friends and family. At this time your pain will be controlled by IV medications and you
will have a catheter placed into your bladder to drain urine. Your incision will be
covered by a sterile dressing which will stay in place for 2 to 3 days.
It is important to begin moving as soon as possible to prevent blood clots and
speed your recovery. The day after surgery you will be visited by a physical therapist
that will assist you. It is important to use your brace while out of bed. Over the course
of your hospital stay, you will gradually increase your activity as tolerated.
Getting out of bed is also a very important step in helping your lung function
return to normal. Areas of your lungs collapse during surgery and a couple of days
post-operatively, which is known as “atelectasis”. Additionally, deep inspirations and
the use of your “incentive spirometer” are essential.
You may shower after 2 days in the hospital, but it is important to keep the
incision dry for 5 days. The nurse will cover your wound with Aquaguard to keep it
dry or you may take a sponge bath.
Patients typically stay in the hospital for 4 days. Before your discharge, you will be provided with a list of “do’s and don’ts” and arrangements will be made for home health if necessary.
Once you arrive home
Continue to walk with the use of aids (i.e. front wheel walker) and your brace.
Slowly increase your activity level. Outpatient physical therapy will begin
between 6 to 8 weeks after surgery.
You may shower, but do not soak in the bath or hot tub for 4 to 6 weeks.
Once the dressing is removed and you are informed to keep it open to the air,
make sure that you protect it from sun exposure. Once the incision is healed,
sunscreen should be on the incision for 6 months to one year. This will help
decrease its appearance.
Maintain a healthy diet, especially one that is high in dietary fiber to decrease constipation. Additionally, a diet rich in protein is ideal for the healing process.
Drink plenty of fluids.
Monitor your incision. It is common to have a small amount of blood and fluid
leakage, however, if there is persistent drainage contact the office. Additionally,
watch for opening of the incision, redness or warmth around the incision, or
fever greater than 101ºF.
No driving for 4 to 6 weeks or until advised.
No lifting greater than 5 pounds for 4 to 6 weeks. No bending at the waist or
twisting the back.
No jumping, running, or high-impact sports. After 2 months, appropriate
exercise include: stair climber, elliptical, stationary bike, and of course walking.
No golfing for a minimum of 3 to 4 months.
Do not take anti-inflammatory medications (i.e. Ibuprofen, Voltaren, Aleve,
Feldene, Lodine, Daypro, Naproxen, Naprosyn, Relafen, and Motrin) for 3
months after the surgery as this may inhibit bone fusion.
Smoking also interferes with bone fusion; therefore patients who smoke should
make every attempt to stop smoking before surgery. If you need additional
assistance, contact 1-800-NO-BUTTS for free information.
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