Problems After Posterior Lumbar Interbody Fusion (PLIF)

Low back pain and instability can be managed with surgery. Pressure is taken off the nerves and the spine is fused to regain stability. The posterior lumbar interbody fusion (PLIF) is one of the best methods of fusion. Patients get good results but there can be problems.

In this study the results of 251 patients having a PLIF were reviewed. All patients had degenerative lumbar disorders. All were treated with the same surgery. This makes it easier and more valid to compare the results. Everyone was followed for at least two years. Some were in the study for more than seven years.

Complications were divided into three time periods: during surgery (intraoperative), early postoperative, and late postoperative. Problems that occurred within the first 30 days were put in the early group. Anything that happened after that was considered a late complication.

Intraoperative problems included nerve injury, poor position of a screw, and tearing of the lining around the spinal cord called the dural sheath. Early complications included infection, hardware failure, and nerve damage. Patients with more serious early problems died from heart attacks, stroke, or blood clots.

Late postoperative problems were similar. There was infection, hardware failure, and failed fusion. Breakdown of the spinal segment next to the fusion was the biggest problem. A second (revision) surgery was done to relieve pressure from nerves compressed by a screw. Hardware failure such as a screw breaking was not treated if there were no symptoms.

The authors reported an overall complication rate of 25 percent. They suggest several ways to reduce problems. Computer navigational systems may be able to help reduce screw malposition. Removing the joint (total facetectomy) is advised as this method gives the nerves more space. Neurologic problems should be treated right away to prevent permanent nerve damage.

Shinya Okuda, MD, et al. Surgical Complications of Posterior Lumbar Interbody Fusion with Total Facetectomy in 251 Patients. In Journal of Neurosurgery: Spine. April 2006. Vol. 4. No. 4. Pp. 304-309.

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