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General information: PLIF&TLIF are surgical techniques to stabilize the spine and
create an iatrogenic spinal fusion of adjoining vertebrae. This includes
removal of the intervertebral disc and replaces it with bone graft or
artificial cage to enhance the fusion, followed by insertion of metal implants
to stabilize the spine. Most common
condition are treated with PLIF/TLIF are spondylolisthesis (slipped vertebra),
degenerative Disc Disease (DDD), and spinal trauma. Patients with a symptomatic
spondylolisthesis may require a complex spinal fusion to decompress trapped nerves
and stabilize the spine.
Target and results: The results of surgery are generally good. 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.
Risk of complications:
- Infection is less than 2 percent. It may affect the superficial
tissues and skin, or may affect
deep spinal structures, diskitis or vertebral osteomyelitis which is very
rare. - Bleeding which may lead to hematoma collection that needs
further surgery. - Cerebrospinal fluid (CSF) leak, inadvertent breach of the
thecal sac may lead to leaking of the fluid surrounding the brain and the
spinal cord. Instant repairs is possible, however, it may need an extended
admission in the hospital or further procedures. There is also very small
risk of meningitis. - Neural tissue injury: the most serious complication may cause
life changing consequences in form of weakness or paralysis of legs,
sphincters, sensory or sexual changes. The risk is very small, <1%. - Worsening of back pain which is about 15% in 5 years related to
adjacent level accelerated degeneration. - Failure of the fusion with loosening of the implants, may need
further surgery/extension of the fixation. - Failure to improve symptoms.
- General anesthetic complications (heart attack, stroke)
- Deep venous thrombosis/pulmonary embolism (clots in legs /
lungs). - Small risk of blindness related to prone position during the
surgery.
Procedure
PLIF&TLIF are standard procedure that is carried out on routine base. The procedure is usually done under general anesthesia and lasts approximately 150 minutes. The operation takes longer than a simple decompression as it involves stabilizing the spine with screws, rods and fusion cages. The patient is positioned on his face (prone), torso is in neutral position. It involves making 10cm midline incision at the lower back, followed by dissection of the muscles on both sides to expose the lamina and facet joints. X-rays guided confirmation of the correct level and guide insertion of the pedicles screws. Spinal decompression is achieved by using Microscope, removal of the thick ligaments and bone to create space and freeing the nerve roots. Intervertebral disc is thoroughly removed and replaced with bone graft or cage. The rods then inserted and connected. Bone graft inserted to enhance spinal fusion.
The wound is closed in layers with dissolvable stitches; skin is closed with clips which need to be removed in 10 days. After the operation, the patient will have a drain in the wound for 24 hours (this is removed on the ward before discharge). Most patients will go home the next day and will be recovering at home for approximately 4 weeks. Following surgery the patient may notice some back pain and stiffness but this should settle with simple pain killers. Specialist spinal physiotherapists will advice each patient on a postoperative exercise regime, to encourage movements. Further outpatient physiotherapy sessions will be offered, where indicated. Patient is usually followed up in the clinic in 8-12 weeks after surgery. If any complication happens, the patient will stay until everything gets sorted. All regular medication will continue except the blood thinning medication like Warfarin, Apixoban, Aspirin, cloidogrel etc, needs advised individually. Most of the cases can started after 48h from the surgery.