RANDALL F. DRYER, M.D.
TOP RATED U.S. SPINE SURGEON
Posterior Lumbar Interbody Fusion
Frequently Asked Questions
Why might I need PLIF (Posterior Lumbar Interbody Fusion)?
Generally speaking, one of the primary indicators that you may need lumbar spine fusion is experiencing lower back pain that lasts for more than six months. The indications for fusing the low back occur primarily in situations where there is a large deformity. These indicators may include:
- Mechanical back pain (usually attributed to disc degeneration)
- Spinal stenosis (narrowing of the spinal canal)
- Spondylolisthesis (slippage of one vertebra against one another)
How will your team know whether I need lumbar fusion?
Our diagnosis process includes reviewing your patient history; performing a physical exam; as well as ordering X-Rays, magnetic resonance image (MRI), or a CT Scan; performing a Discogram; and testing EMGs.
Are there any treatment alternatives besides surgery?
It’s a possibility there are other treatments available to help you avoid surgery. Before we perform surgery, we will look at less invasive options, such as:
- Medication options
- Continuing to live with condition
- Physical therapy (exercises and stretching)
- Chiropractic manipulation
- Epidural Steroid Injections (ESIs)
- TENS Units
What is the purpose of this procedure?
The primary purpose of posterior lumbar interbody fusion is to stabilize the spine (stop the motion) by restoring the disc height and alignment with metal cages and fusing the vertebra together using the patient’s own bone or a genetically engineered substance known as Bone Morphogenetic Protein (BMP).
Where does the bone for fusion come from? Is one option better than the other?
There are currently two primary alternative sources for the bone needed for the spinal fusion. Traditionally, some of the patient’s own bone has been harvested from the iliac crest (pelvic bone). This technique produces excellent results for the fusion.
Early in 2003, the FDA approved a genetically engineered bone substitute for use in spinal fusions. Under the brand name, InFUSE, BMP converts stem cells into bone forming cells and stimulates rapid growth of bone at the targeted site. Using BMP eliminates the need for harvesting the patient’s own bone and speeds up the fusion process.
Using either form of bone graft can yield a high rate of fusion, but neither is 100 percent guaranteed effective%. BMP has tended to give better rates of fusion than other graft materials, including pelvic bone.
What are the cages made of?
Metal cages are usually made of titanium. Newer cages are being made of carbon fiber and special inert synthetic compounds. These have the advantage of not setting off airport screening detectors
What are the disadvantages of approaching from the posterior (back)?
When approaching the site through the posterior, substantial retraction of the nerve roots is necessary for the surgeon to gain access to the disc space. Significant traction can injure the nerve root and has the potential to result in chronic leg and back pain. The pain associated with this type of nerve root injury can be severe, and there are no effective options for treatment.
There are numerous veins (epidural veins) over the disc space, and surgery in this area creates the potential for excessive blood loss during the surgery. This very rarely occurs.
Who will be involved in the procedure?
- Surgeon – The orthopedic spine surgeon that you have been seeing in our office will be the primary surgeon, in charge of your surgery.
- Vascular Surgeon/co-surgeon – The vascular surgeon is a specialist who will watch over the epidural veins during the surgery.
- Assistant Surgeon – Another orthopedic spine surgeon, usually from our office, will assist your orthopedic surgeon with the procedure. This is done to minimize the length of time you are under general anesthesia and to provide the necessary assistance with the actual surgical procedure.
- Anesthesiologist – The doctor who actually administers and monitors the anesthesia is a critical part of the surgical team. You will normally meet with the Anesthesiologist during your pre-op appointment at the hospital.
How long will the surgery take?
One to two hours are typical for one or two-level fusion procedure.
What can I expect from my hospital stay?
With most spinal surgeries, patients are up and walking within hours after their procedure. It is no longer necessary, or recommended, that you lie in bed for days or weeks after spine surgery. Nurses who are experienced in working with spinal surgery patients will assist you during your first few efforts at getting out of bed and walking.
Your doctor will tell you when it is safe to shower after surgery. Showers are usually allowed 2-3 days after surgery. Soaking in a bathtub is not allowed at any point until cleared by your doctor.
Are there any restrictions to caring for my incision?
The nursing staff at the hospital will show you how to keep the dressing dry and in place to protect the incision while showering. The wound should not be submerged in water (pool or tub) until it has healed and has been cleared by your doctor. The nurse will change the dressing after your shower, and again later if necessary.
Your surgical incision will be checked during your first post-op appointment. However, should your incision become red and tender or drainage occur, prior to your first scheduled post-op visit, you should contact our office for instructions.
How soon will I be allowed to eat after the surgery?
Liquids are allowed right after surgery. Solid foods are not started for several days. Your doctor will give you specific instructions.
How much pain should I expect and how is it treated?
Your doctor’s goal is to keep you as comfortable as possible. Almost all strong pain medications are narcotics that tend to make you sleepy and can depress your breathing. We must balance the side effects with our goal to relieve pain. In the hospital, patient controlled (IV) medications are given the first day. We then switch to oral medications.
Once you leave the hospital, you will be prescribed have pain pills for home use. We will continue home medications as needed, with the goal of weaning them as you recover.
It is important to tell your doctor of any allergies to medicines and to only use pain medications as directed. Mixing medications can be dangerous.
We do not refill pain medications after hours or on weekends. You must ask ahead 1-2 days if you are going to run out of pain pills. Refills of medications are at your doctor’s discretion.
How long will it take me to return to my normal living routine?
It normally takes approximately 3 to 6 months for the fusion to occur. During that time you should avoid strenuous activities that might affect the fusion process.
During the rehabilitation process it is important to recondition the muscles with exercise, stretching and aerobic conditioning. Your doctor will give more specific instructions during the course of your post-operative care during your office visits.
Driving is not allowed until after your first post-op visit (Usually 7-10 days). Most patients are able to go up and down stairs when they go home from the hospital, though. Some patients may require additional assistance.
How soon will I be able to return to work?
Returning to work is determined individually for each patient, and is based on several factors. The doctor’s goal is to help you return to work as soon as you can do so safely. If you have a light or sedentary job or if light duty restrictions are available, then return to work could occur in 10-14 days. If you are able to work from home by phone, fax, and computer, very early work may be realistic. If your job involves heavy and strenuous manual labor, returning to work can take several months.
Other factors that play a role in return include your overall physical condition, tolerance of pain and need for additional therapy.
Even the best results of surgery do not mean that you will necessarily be able to return to your prior type of job. Some patients are advised to go through job re-education or find a lighter job for future back safety.
How long does healing take?
It normally takes approximately 3 months for the fusion to occur. During that time you should avoid strenuous activities that might affect the fusion process.
During the rehabilitation process, it is important to recondition the muscles with exercises, stretching and aerobic conditioning. Your doctor will give you more information on that process.
What are the risks and potential complications?
The potential risks or complications that might occur with PLIF could include:
- Complications from Anesthesia
- Continued Low Back or Leg Pain
- Fusion May Not Occur (higher incidence of non-fusion in patients who smoke)
- Hardware (i.e. cages may break or come loose)
- Numbness Numbness
- Nerve Damage
- Loss of Sexual Function
No guarantees can be made as to the success of this procedure.
If your primary care provider has referred you to a spinal specialist, we at Central Texas Spine Institute are the experts. Call us with any questions you may have or make an appointment today!
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