Instrumented Fusion Surgery / Posterior Lumbar Interbody Fusion (PLIF) and / Transforaminal Lumbar Interbody Fusion (TLIF) and Anterior Lumbar Interbody Fusion (ALIF)

Spinal fusion and spinal instrumentation are surgical procedures used to stabilise the spine. During a spinal fusion, two or more vertebrae are joined together using bone grafts or specialised implants to encourage the bones to heal into a single solid structure. Spinal instrumentation is often used in conjunction with fusion surgery and involves the placement of implants such as rods, screws, plates, or cages to provide additional support and stability while the fusion heals.

Conditions Treated

Lumbar fusion surgery may be recommended to treat a range of spinal conditions, including:

• Degenerative disc disease
• Herniated or damaged discs
• Spondylolisthesis (slipped vertebrae)
• Spinal instability
• Spinal tumours
• Spinal fractures and other traumatic spinal injuries
• Certain cases of recurrent nerve compression or deformity

Procedure

Lumbar fusion surgery is performed under general anaesthesia. Depending on the surgical approach, an incision is made in the back, side, or abdomen to access the affected area of the spine.

The surgeon removes part or all of the damaged intervertebral disc between two adjacent vertebrae. The disc space is then prepared, and an interbody cage, bone graft, or other implant is inserted to restore disc height and promote fusion. Additional instrumentation, such as rods and screws, may be used to stabilise the vertebrae while the fusion develops.

The three most common lumbar fusion techniques include:

• Posterior Lumbar Interbody Fusion (PLIF) – performed through an incision in the back using a posterior approach.
• Transforaminal Lumbar Interbody Fusion (TLIF) – also performed through a posterior approach but accesses the disc space from one side of the spine to minimise disruption of surrounding structures.
• Anterior Lumbar Interbody Fusion (ALIF) – performed through an incision in the abdomen using an anterior approach to access the spine from the front.

During an ALIF procedure, a vascular surgeon may be required to assist with safely accessing the spine, depending on the spinal level being treated.

Each fusion technique has specific advantages, risks, and indications. Dr Tollesson will discuss these options with you and recommend the most appropriate procedure based on your symptoms, overall health, age, imaging findings, and medical history.

Recovery

Recovery varies depending on the individual patient, the condition being treated, and the type of fusion performed.

As a general guide, recovery may include:

• A hospital stay of approximately five to seven days
• Avoidance of heavy lifting during the initial recovery period, with gradual progression of activity as advised
• Time away from work to allow for healing and recovery
• A temporary return to work on modified or restricted duties, if required
• Restrictions on driving for approximately four to six weeks, depending on recovery progress and medical advice
• Avoidance of swimming for four to six weeks
• Physiotherapy and rehabilitation, as required
• Ongoing pain management, if necessary
• Use of a back brace in some cases
• Assessment and support from an Occupational Therapist, if required

Following surgery, it is normal to experience some back discomfort, stiffness, and fatigue while healing occurs. Recovery timelines vary, and Dr Tollesson will provide specific recommendations based on your procedure and individual recovery progress.