Our Summary

This research paper discusses the history and development of a spinal surgery technique called the posterior lumbar interbody fusion (PLIF), which is now considered the gold standard in spinal fusion surgeries. The PLIF technique was first introduced in the 1940s, but it was not widely accepted for several decades due to various controversies and objections. It was only through the determination and skills of a few pioneering surgeons that the procedure was eventually recognized as an ideal method for spinal fusion. The acceptance and popularity of PLIF have helped surgeons understand the complex mechanics of the spine better and have paved the way for many successful modern spinal surgeries. This paper aims to present the untold story of the origins and development of the PLIF technique.

FAQs

  1. What is posterior lumbar interbody fusion (PLIF) and why is it considered the gold standard in spinal arthrodesis?
  2. Why was the reputation of PLIF marked with animosity for fifty years after its first performance in the 1940s?
  3. How has the popularization of PLIF influenced the surgical community’s understanding of spinal biomechanics?

Doctor’s Tip

One helpful tip a doctor might tell a patient about lumbar fusion is to follow all post-operative instructions carefully, including proper wound care, activity restrictions, and physical therapy exercises. It is important to give your body enough time to heal and to gradually increase activity levels as directed by your healthcare provider to ensure the best possible outcome from the surgery.

Suitable For

Patients who may be recommended lumbar fusion include those with degenerative disc disease, spondylolisthesis, spinal stenosis, fractures, tumors, infections, or deformities. Additionally, patients who have not responded to conservative treatments such as physical therapy, medication, and injections may also be candidates for lumbar fusion. It is important for patients to undergo a thorough evaluation by a spine specialist to determine if lumbar fusion is the most appropriate treatment option for their specific condition.

Timeline

Before lumbar fusion:

  • Patient experiences chronic back pain, leg pain, and/or numbness that does not improve with conservative treatments such as physical therapy, medication, or injections.
  • Patient undergoes imaging tests such as X-rays, MRIs, or CT scans to determine the cause of their symptoms.
  • Patient consults with a spine surgeon who recommends lumbar fusion as a treatment option.
  • Patient undergoes pre-operative evaluations and tests to ensure they are a suitable candidate for surgery.

After lumbar fusion:

  • Patient undergoes the lumbar fusion procedure, which involves removing the damaged disc and inserting a bone graft or implant to stabilize the spine.
  • Patient stays in the hospital for a few days for monitoring and pain management.
  • Patient undergoes physical therapy and rehabilitation to regain strength and mobility.
  • Patient follows a post-operative care plan, including medication management, follow-up appointments, and restrictions on activities to allow for proper healing.
  • Patient experiences improvements in their symptoms over time as the spine heals and stabilizes.

What to Ask Your Doctor

  1. What is the success rate of lumbar fusion surgery?
  2. What are the potential risks and complications associated with lumbar fusion surgery?
  3. How long is the recovery period after lumbar fusion surgery?
  4. Will I need physical therapy after the surgery?
  5. Are there any alternative treatments to lumbar fusion that I should consider?
  6. How long do the effects of lumbar fusion surgery typically last?
  7. What type of hardware will be used in the fusion procedure?
  8. Will I need to make any lifestyle changes after the surgery?
  9. What is the likelihood of needing additional surgeries in the future after lumbar fusion?
  10. How soon after the surgery can I expect to see improvement in my symptoms?

Reference

Authors: Fenton-White HA. Journal: Spine J. 2021 Sep;21(9):1528-1541. doi: 10.1016/j.spinee.2021.03.016. Epub 2021 Mar 20. PMID: 33757870