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POSTERIOR LUMBAR INTERBODY FUSIONPatients with a
symptomatic slipped vertebra (spondylolisthesis) may require a complex spinal
fusion to decompress trapped nerves and stabilise the spine. This is aimed at
improving the patient’s leg symptoms. Whilst it may improve some back symptoms
it will not cure back pain. The operation is usually only carried out when more
conservative measures have been tried and failed.
PLIF surgery is
carried out under a general anaesthetic and takes approximately 3 hours. It takes longer than a simple
decompression as it involves stabilising the spine with screws, rods and fusion
cages. The incision is usually 15-20cm long, but new minimally invasive
techniques are being trialled at present using a much smaller incision, and
causing less muscle damage.
The wound is closed
using skin clips that need to be removed 1 week after surgery – this can be
done by the ward staff or by the practice nurse at the GPs surgery. Most
patients have a wound drain, which is removed 24 hours after surgery. Patients
are usually well enough to go home the day after surgery and will be recovering
at home for another 6-8 weeks.
The risks of the
operation include:
Wound
infection (2%)
Spinal
fluid leak (1%)
Blood
clot at operation site requiring re-operation (1%)
Nerve root injury resulting in worsening leg pain, numbness, weakness or
paralysis (1%)
Cauda equina injury resulting in leg weakness, incontinence or impotence
(1 in 2000)
No improvement in symptoms (10%)
Failure of the spinal fusion construct requiring further surgery (1%)
General
anaesthetic risks, including a small risk to life
Following surgery the
patient may notice some back pain and stiffness but this should settle with
simple anti-inflammatory medication, such as Neurofen. Some patients will
develop tingling in the legs after surgery. This is due to swelling in the
nerve following manipulation at surgery. It is temporary and will settle down
after a few days.
Patients do not
usually need to wear a back brace or support. A specialist physiotherapist will
advice each patient on a postoperative exercise regime, to encourage back
movements, rather than restrict them. Long term fusion rates are improved if
the patient doesn’t smoke during the recovery period.
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