POSTERIOR LUMBAR INTERBODY FUSION

Patients 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.