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Postero Lateral spinal fusion PLF in Mukundapur

Postero Lateral Spinal Fusion PLF

Postero Lateral Spinal Fusion PLF in Mukundapur

A surgical treatment called Spinal Fusion is performed to treat issues with the vertebrae, the small bones that make up the spine. In essence, it's a welding procedure. The main concept is to create a single, solid bone by fusing together the troublesome vertebrae. When mobility is the cause of the pain, one possibility for therapy is Spinal Fusion, which operates under the premise that afflicted vertebrae shouldn't ache if they are immobile.

The two techniques for joining the lower back, or lumbar spine, are:

  • Posterior Lumbar Interbody Fusion (PLIF): Your surgeon inserts the spacer or cage during Posterior Lumbar Interbody Fusion (PLIF) from the rear of the spine. By cutting the bone (lamina) and pulling the nerve roots to one side, your surgeon can reach your spine. After that, a spacer can be introduced, and the intervertebral disc's back can be removed.

  • Transforaminal Lumbar Interbody Fusion (TLIF): This method is similar to a PLIF version. The surgeon approaches the disc space in the Transforaminal Lumbar Interbody Fusion (TLIF) from a somewhat different angle. This method has the benefit of requiring less movement of the nerve roots, which should reduce the risk of nerve damage.

FAQ's

Transforaminal Lumbar Interbody Fusion (TLIF) is recommended for conditions like spondylolisthesis, where one vertebral body slips over another; degenerative disc disease with foraminal stenosis causing nerve compression; recurrent disc herniations; and pseudoarthrosis from a previous failed fusion. TLIF may be preferred over Posterior Lumbar Interbody Fusion (PLIF) when disc degeneration is predominantly one-sided, leveraging the surgeon’s expertise for optimal outcomes in pain relief and spinal stability.

TLIF is often preferred over Posterior Lumbar Interbody Fusion for predominantly one-sided disc degeneration, contingent on the surgeon's expertise. However, TLIF is contraindicated in cases of active neurological issues or weakened bones, such as extensive epidural scarring, arachnoiditis, active infections, conjoined nerve roots, and osteoporosis. General contraindications for spinal fusion, including severe osteoporosis and conditions obstructing disc space access, also make TLIF an unsuitable option.

The patient is placed face-down under general anaesthesia before the TLIF surgery starts. After the surgical site is ready, either two tiny incisions (minimally invasive TLIF) or a single vertical incision (open TLIF) are made. To gain access to the spine, the muscles are pulled back, and screws are inserted for stability. The lamina and/or facet joint are removed to reveal the disc space. In order to restore disc height and relieve nerve pressure, the injured disc is removed and replaced with a bone graft and spacer. Vertebrae are stabilised by screws fastened to rods or plates. Sutures are used to seal the wound, and X-rays guarantee that the hardware is placed correctly.

Incisions: Both TLIF and PLIF involve incisions to the posterior lumbar spine.

Disc Approach:

  • PLIF: Approaches the disc from the midline, requiring retraction of nerve roots, increasing injury risk.

  • TLIF: Approaches the disc from the side, with minimal or no nerve root retraction.

Procedure:

  • PLIF: Retracts nerve roots.

  • TLIF: Removes spinal facets and accesses the disc through the intervertebral foramen.

Fusion: Both procedures insert a spacer to fuse two vertebrae.

Most patients go home 3-5 days after surgery, receiving guidance from physical and occupational therapists. They should avoid bending, lifting heavy objects, and twisting for the first 2-4 weeks to prevent strain or injury. Brace use is not required, and wound care involves keeping the area clean and dry, and changing bandages every 1-2 days. Showering is allowed with precautions, but bathing is restricted until the wound heals in about 2 weeks. Driving can resume after 7-14 days if pain is mild and no narcotics are used. Return to work and sports varies, starting from 2-3 weeks for light duties.

Every surgical method, whether it be side, rear, or front, has benefits and drawbacks. A Posterior/Transforaminal Spinal Fusion may provide the following benefits:

  • Direct access to the bone applies force to the nerves

  • Permits the surgeon to remove old hardware during a revision procedure

  • Increased spinal bone alignment

  • Furthermore, a less invasive approach for transforaminal fusion may be used, which would lessen the risk of muscle damage

The Posterior/Transforaminal operation often has a complication rate comparable to that of conventional spine surgery. Potential drawbacks consist of:

  • Nerve damage, resulting in less weakness

  • Possibility of the cage moving and applying pressure to the nerves

  • Hematoma, or bleeding into the muscle, can result in weakness by compressing the nerves

Discuss with your surgeon the best course of action for your particular medical needs.

If only one level is fused, patients usually return home the same day or the following day. Most patients who have several levels fused spend the night in the hospital. Patients should watch for any leg weakness that causes them to buckle after returning home, and they should notify the surgeon right away if this happens.

Usually, a few days to several weeks are required for pain management. You can also receive a brace from your surgeon to aid in the healing of the fusion. Posterolateral/Transforaminal Lumbar Interbody Fusion results are comparable to conventional operations. In certain instances, this treatment can be carried out with a smaller incision, perhaps reducing the amount of muscle injury.

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