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Learn about spinal fusion surgery

Mr Irfan Malik, one of our complex spine experts, explains all you need to know about spinal fusion surgery and explain what the confusing acronyms mean.

You may be wondering what a PLIF, TLIF or an ALIF is? You may also want to find out about all of the different spinal fusion surgery options that are out there. You can read about them one at a time, but it doesn’t mean that you will understand them.

Spinal fusion surgery is an operation that is done to make two segments of the spine join and become one, to fuse the segments. The spine consists of a number of different components, which includes:

  • Bones which are essential for providing support

  • Discs which are placed in between each bone to act as shock absorbers

  • Ligaments which hold it all together

  • Muscles which provide movement and strength

As we get older, or sometime due to a trauma, the discs can start to cause a problem in the spine as they start to degenerate. This can lead to back pain, and can also be accompanied with pain down the legs, similar to the pain that someone will experience if they have sciatica. If this is left to progress, it can result reduction or loss of function in the lower limbs, such as foot drop or weakness in the legs; whatever symptom you get, it needs to be treated.

How can we you go about doing this?

The easiest and simplest way is to have decompression surgery, this involves removing part of the bone to remove the pressure from the spinal cord and the nerves. When a nerve is trapped or compressed, it will be under a lot of pressure, which can result in leg pain, weakness or numbness. If this is left for a long period of time, more bone may need to be removed, which can cause the spine to become unstable. If this is the case, an instrumentation will have to be used during surgery that holds the spine in place while the bones grow back and therefore becomes stable again. This is where the PLIF, TLIF and ALIF comes in.

What is a PLIF, TLIF and ALIF?

A PLIF (Posterior Lumbar Interbody Fusion) is surgical procedure where the lower spine (lumbar) is approached from the back (posterior), next the disc is removed (this is the interbody part- i.e. between the vertebral bodies) and then replaced with either a cage or spacer to replace the discs height and allows the nerve to be free and have space to move. Later a screw is put in the level above and below the affected disc, which is done in order to keep the spine segment stable. By doing this it allows time for the bones to grow around the edge and form one spinal segment rather than two (this is the fusion part of the surgery). Bone growth can be encouraged by putting bone grafts down the edge of the spine bones, while the new bone is growing the screws are still in place to ensure that everything remains stable.

A TLIF is the same operation, just from a different approach. Instead of being called posterior lumbar interbody fusion, it is called transforaminal lumbar interbody fusion. This means that the affected disc is usually approached on one side (usually around 2-3 centimetres from the centre of the back, rather than directly from the back). This surgery is also usually carried out using a minimally invasive techniques such as keyhole surgery, meaning that the incision mark is significantly small than more traditional methods.

An ALIF (anterior lumbar interbody fusion) is different to the other procedures. During this procedure the affected area of the spine is approached through the anterior aspect (stomach), once the disc has been removed it is replaced with a large spacer. This is usually aided with minimally invasive posterior fixation, from the back of the patient.

The final procedure is an XLIF (extreme lateral lumbar interbody fusion). This is when the patient is placed on their side and the affected area of spine is accessed directly from the side of the patient, past the iliac crest. Similar to the other procedures, this is often accompanied by screws in the bone hold everything in place while the bone fusion takes place.

Recovery time varies depending on the type of fusion that the patient has had and the general health of the patient. It is hard to say an exactly time frame for when the patient will be fully recovered, but it is normal for them to return home within a couple of days after the surgery and to be getting back to normal activities usually within around 6 weeks.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

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