Posterior Lumbar Interbody Fusion (PLIF) is one of the primary techniques for the treatment of lower back disorders.
Specifically, the abbreviation PLIF stands for:
✔️ Posterior, meaning from the back
✔️ Lumbar, referring to the lumbar spine in the lower back
✔️ Interbody, meaning the area between two adjacent vertebral bones in the spine
✔️ Fusion, referring to the process of two bones becoming one
In this surgical procedure, the intervertebral disc is removed from the posterior side of the spine. An open medial approach with muscle dissection to both sides or a minimally invasive Wiltse approach with paramedian muscle dissection can be used to access the posterior spine. A surgery for the spine involves making a 3 to 6-inch cut in the middle of your back. This allows the surgeon to reach one or two levels of your spine. They carefully move the muscles to access the spine’s bones and joints. They remove part of the bone and spine to relieve pressure on nerves and make space for implants. Then, they remove the damaged disc material and prepare the bones for fusion. Finally, they place implants and bone grafts to support the spine.
The PLIF technique is used to treat degenerative conditions such as segmental instability, recurrent herniated disc, symptomatic spinal stenosis and pseudarthrosis. Contraindications for posterior access fusion surgery include extensive intradural scarring, meningitis and active infection.
In the case of PLIF, the choice of the right implant plays a key role. Syntropiq offers innovative implant solutions specifically tailored to this technique. The Dynam’X Perseus, an implant along with a set of instruments, has been designed with the PLIF procedure in mind. The Perseus Lumbar Cage, which is part of the Dynam’X system, features a titanium mesh to allow free flow of bone cells. The implant can be filled with bone substitute or allogeneic graft before or after implantation. The Perseus system offers two implant insertion tools, providing a versatile stabilization option, while the advanced DCS Syntropiq technology initiates an accelerated bone remodelling process, reducing fusion time and creating new bone scaffolds.
Advantages of the PLIF procedure include:
✔️ a traditional approach that is quite common among spinal surgeons,
✔️ excellent visualisation of the nerve roots without compromising the blood supply to the graft, ✔️ restoration of adequate intervertebral height,
✔️ nerve decompression while preserving the support of posterior spinal structures, and, most importantly, the potential for 360-degree fusion through a single incision.
Unfortunately, this procedure is not without its drawbacks, such as the risk of significant paraspinal muscle injury associated with prolonged muscle inversion, the difficulty in correcting body imbalance and restoring lordosis, problems with endoplatal preparation compared to anterior approaches, and the potential risk of nerve root damage associated with inversion, which can lead to chronic radiculopathy.
As a result, the PLIF procedure is an effective way to treat lower back disorders and, thanks to innovative implants from Syntropiq, surgeons have the tools to significantly improve the efficiency and safety of this type of surgery.