PLIF, ALIF and TLIF Procedures

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Spinal fusion is a surgical procedure in which two or more vertebrae are joined or fused together. Fusion surgeries typically require the use of bone graft to facilitate fusion. This involves taking small amounts of bone from the patient’s pelvic bone (autograft), or from a donor (allograft), and then packing it between the vertebrae in order to “fuse” them together. This bone graft, along with a biomechanical spacer implant, will take the place of the intervertebral disc, which is entirely removed in the process. Spinal fusion surgery is a common treatment for such spinal disorders as spondylolisthesis, scoliosis, severe disc degeneration, or spinal fractures. Fusion surgery is usually considered only after extensive non-operative therapies have failed. Three common fusion surgeries available at our practice include PLIF, ALIF and TLIF.

PLIF
PLIF stands for Posterior Lumbar Interbody Fusion. In this fusion technique, the vertebrae are reached through an incision in the patient’s back (posterior). The PLIF procedure involves three basic steps:


Pre-operative planning and templating. Before the surgery, the surgeon uses MRI and CAT scans to determine what size implant(s) the patient needs.
Preparing the disc space. Depending on the number of levels to be fused, a 3-6 inch incision is made in the patient’s back and the spinal muscles are retracted (or separated) to allow access to the vertebral disc. The surgeon then carefully removes the lamina (laminectomy) to be able to see and access the nerve roots. The facet joints, which lie directly over the nerve roots, may be trimmed to allow more room for the nerve roots. The surgeon then removes the affected disc and surrounding tissue and prepares bone surfaces of adjacent vertebrae for fusion.
Implants inserted. Once the disc space is prepared, bone graft, allograft or BMP with a cage, is inserted into the disc space to promote fusion between the vertebrae. Additional instrumentation (such as rods or screws) may also be used at this time to further stabilize the spine.

TLIF

TLIF stands for Transforaminal Lumbar Interbody Fusion. This fusion surgery is a refinement of the PLIF procedure and has recently gained popularity as a surgical treatment for conditions affecting the lumbar spine. The TLIF technique involves approaching the spine in a similar manner as the PLIF approach but more from the side of the spinal canal through a midline incision in the patient’s back. This approach greatly reduces the amount of surgical muscle dissection and minimizes the nerve manipulation required to access the vertebrae, discs and nerves. The TLIF approach is the preferred method at our practice for interbody fusion as it is generally less traumatic to the spine, is safer for the nerves, and allows for minimal access and endoscopic techniques to be used for spinal fusion.

As with PLIF and ALIF, disc material is removed from the spine and replaced with bone graft (along with cages, screws, or rods if necessary) inserted into the disc space. The instrumentation helps facilitate fusion while adding strength and stability to the spine. We currently use many state of the art cage technologies including those made of bone, titanium, polymer, and even bioresorbable materials.

ALIF

ALIF stands for Anterior Lumbar Interbody Fusion. This procedure is similar to PLIF, however it is done from the front (anterior) of the body, usually through a 3-5 inch incision in the lower abdominal area or on the side. This incision may involve cutting through, and later repairing, the muscles in the lower abdomen.

At our practice, a mini open ALIF approach is available that preserves the muscles and allows access to the front of the spine through a very small incision. This approach maintains abdominal muscle strength and function and is oftentimes used to fuse the L5-S1 disc space.

Once the incision is made and the vertebrae are accessed, and after the abdominal muscles and blood vessels have been retracted, the disc material is removed. The surgeon then inserts bone graft (and anterior interbody cages, rods, or screws if necessary) to stabilized the spine and facilitate fusion.

Minimal Access
We routinely do several types of spinal procedures utilizing minimal access techniques. The development of these techniques originated with the application of endoscopy during microdiscectomy surgery for herniated lumbar discs. It has now been applied to fusion surgeries. Ask a member of our clinical team to see if this might be right for you.

After Fusion Surgery
Recovery time is different for every patient. However, most patients are up and walking by the end of the first day after surgery. Most patients can expect to stay in the hospital for 3-5 days depending on their condition. Once released from the hospital, patients who have undergone a PLIF, ALIF, or TLIF procedures are given a prescription for pain medications to be taken if needed, as well as a detailed post-operative activity plan to help ease recovery and return to a healthy life.

Case Example of Degenerative Spondylolisthesis treated with TLIF







This 58 year old woman had degenerative spondylolisthesis at the L4/5 level as shown on the x-ray and MRI above. She had difficulty walking distances and back and leg pain. She was treated with laminectomy and fusion with instrumentation.

Prescription and Non-Prescription Drugs for Back Pain.

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Medication Compendium

Learn more about medications spine and pain specialists prescribe or understanding your prescription.

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Information About Medications
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There are several different types of medications used to treat back pain. Many of the commonly prescribed drugs are discussed in detail.
Drug Preparations Applied to the Skin Help Relieve Pain
Acetaminophen in the Treatment of Acute Low Back Pain
NSAIDs in The Treatment of Acute Low Back Pain
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How do Topical Drugs Reduce Back and Neck Pain?
Drugs Used to Treat Pain: Opioids - Narcotics
Understanding Your Prescription - What does it Say?


Vitamins and Supplements
Vitamins Supplements and Herbs
An index of Vitamins Supplements and Herbs
Herbal Supplements: Questions and Answers
The Role of Vitamins

Understanding Your Prescription - What does it Say?
Susan Spinasanta
Medical Writer
SpineUniverse
Desert Hot Springs, CA, USA


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Have you ever wondered how the pharmacist manages to read the doctor’s handwritten prescription? It must be an art!

Seriously, how would you decipher “drug name 250 mg PO bid x 5 days?” To start, the first part of a prescription is the name of the drug; it can be a brand name or generic. The next part - “250 mg” denotes the strength of the drug - in this case two-hundred-fifty milligrams. “PO” means the medication is taken by mouth “bid” or twice a day. The ‘x’ indicates this prescription is taken for a period of 5 days.

Some people think that Rx means prescription. In a way it does. However, Rx is the abbreviation for the Latin word meaning ‘recipe’. The abbreviations used in prescriptions are derived from Latin terms. Listed below are many commonly used today.



Abbreviation
Meaning
Latin Term

ac
before meals ante cibum

bid
twice a day bis in die
cap capsule capsula
gt drop gutta
hs at bedtime hora somni
od right eye oculus dexter
os left eye oculus sinister
po by mouth per os
pc after meals post cibum
pil pill pilula
prn as needed pro re nata
q2h every 2 hours quaque 2 hora
qd every day quaque die
qh every hour quaque hora
qid 4 times a day quater in die
tab tablet tabella
tid 3 times a day ter in die


Understanding your prescription entails more than just filling it at the pharmacy. Remember - no drug is without risk. The following guidelines are designed to help you at your doctor’s office, the pharmacy, and at home.

With Your Doctor

Make sure your doctor knows everything about your medical history. Be sure to include past reactions (i.e. rashes, indigestion, dizziness, loss of appetite) to medications, even if minor.

Do you take vitamins, supplements, and/or herbs? It is important your doctor knows what you take, how much, and how often. Why? Some supplements are known to react with certain drugs.

Over-the-counter (OTC) medications are drugs! Just because they can be purchased without a prescription does not mean they can be taken without risk. Make your doctor aware of precisely what you take, the dosage, frequency, and why.

Ask your doctor the name of the medication being prescribed. What is the drug used for - how is it suppose to work - the possible side effects - will your activity level be affected - can it be taken with coffee, alcohol, dietary supplements, and so on.

While you are with your doctor, discuss the use of the medication. What is the correct dose, how often it is to be taken, what to do if a dose is missed, possible interactions with other medications taken (including OTC), and what to do if a reaction to the drug occurs.

Take notes! This will help you remember when you get home.

Feel free to ask your doctor for available written information about the specific drug to be prescribed.


At the Pharmacy

Does your pharmacist have your ‘patient profile’? Many pharmacies ask for information that is included in your record such as allergies and other medications taken. This may prevent a drug interaction problem.

Are there children or young adults in your home? If so, ask for tamper resistant caps. In this case, an ounce of prevention may eliminate the need for a cure!

Ask your pharmacist to include what the drug is used for on the label.

If you don’t remember how to take your prescription, ask the pharmacist. Many pharmacies ask patients if they have questions before they leave with the prescribed medication.

In some cases, the doctor will telephone your prescription (i.e. refill) into the pharmacy. It is a good idea to review the dose and frequency with the doctor or pharmacist.

If a new drug has been prescribed, ask the pharmacist to fill half the prescription. If a reaction or side effect develops, you will have saved yourself half the total cost.

Will you be traveling to a different climate? Some medications do not work properly if the patient is exposed to the sun or other element.

Some pills or tablets are large and may be difficult to swallow. Check with the pharmacist before crushing or splitting. Some drugs can only be taken swallowed whole.


At Home - Tips for Medication Safety

Do you have children in your household? If so, don’t keep your medication in the nightstand or your purse. Always keep drugs in a secure locked area.

Keep an antidote such as Syrup of Ipecac on hand just incase. This is used to induce vomiting if a poison is swallowed. Familiarize yourself with the dosing directions and precautions prior to an unexpected emergency. Post the phone numbers for your poison control center and EMS.

If you experience a reaction or any side effects, call your doctor immediately.

Do not mix your medication in with other drugs and their containers. Keep each medication in the bottle it came in. Mixing drugs in one container can alter their stability.

Keep you medication in a dark, dry, and cool (not refrigerated unless designated) area. Heat, light, and moisture can affect a drug’s stability.

Always take your medication as directed by your doctor. Drugs strong enough to heal can also hurt if taken incorrectly.

Never share or take anyone else’s medication.

Do not take medication in the dark.

Only give a child medication when you are fully awake and alert.

Some prescriptions or OTC products come with cups for dosing. Cups differ in size and dosing measurements. Do not use a cup from another product.

When the prescription expires, destroy the unused medication and bottle. Some pharmacies will take care of this for you.

Keep a list including your medical history and drugs taken on a regular basis (dose and frequency) in your wallet near your insurance identification. This information may come in handy during a medical emergency.


Understanding your prescription is a key to treating the condition for which it was prescribed. Taking the above medication tips into consideration may help you and your family to be healthy and safe.