Posterior Lumbar Interbody Fusion and Decompression

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Grade I or II spondylolisthesis
  • Back pain or radicular symptoms that fail to improve with adequate conservative treatment
CONTRAINDICATIONS
  • Grade III or greater slips (unless partial reduction is obtained and maintained by segmental instrumentation posteriorly)
EQUIPMENT
  • Fluoroscopy unit
  • Pituitary rongeurs
  • Pedicle screws
  • Curets
  • Bone chisel
  • Tamps
  • Mesh or trapezoidal carbon fiber cages
  • Allograft struts
  • Structural graft or interbody implant
  • 16-gauge angiocatheter
  • 5 mL of 1 mg/mL preservative-free morphine
ANATOMY
  • A defect in the pars interarticularis interferes with the bony hook (pedicle, pars, inferior articular facet of the cephalad vertebra, and superior articular facet of the caudal vertebra) of the affected spinal motion segment.
  • The defect weakens the structural linkage, which can then no longer resist translational instability.
  • As a result, the posterior elements separate through the pars fracture, causing anterior translation of the entire trunk over the sacrum or caudal vertebral body.
  • The increased shear stresses on the intervertebral disc contribute to the formation of foraminal stenosis and radiculopathy.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Use single-dose epidural or parenteral narcotics for pain control initially, and transition to oral medications before discharge.
  • Use thigh-high anti-thromboembolic disease hose and pneumatic compression devices until the patient is ambulatory.
  • Maintain a bladder catheter until the patient is mobile enough to get to the bathroom or a bedside commode.
  • Discontinue the drain on the day after surgery unless there has been excessive drainage.
  • Advance the patient's diet as tolerated.
  • Begin physical therapy the day after the procedure with initial patient mobilization, and encourage walking as tolerated.
  • Advise the patient to refrain from smoking and avoid the use of aspirin and nonsteroidal anti-inflammatory medications until the fusion is solid.
  • The use of an orthosis is optional after PLIF.
COMPLICATIONS
  • Infection
  • Cauda equina deficits
  • Foot drop
  • Pseudoarthrosis
  • Progressive slip
RESULT ANALYSIS

When used to treat grade I and II adult spondylolisthesis, PLIF produces reliable results in most patients. Results are less predictable in grade III or higher slips unless partial reduction and fixation is used in conjunction with the PLIF.

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