Lumbar posterior discectomy + interbody fusion (PLIF/TLIF)

What is This Treatment?

Lumbar posterior discectomy and interbody fusion is the removal of disc material causing pain and instability in the lumbar spine and placement of a cage with bone graft into the disc space to achieve fusion between two vertebrae. PLIF and TLIF serve the same basic purpose; the difference is the angle and extent of tissue preservation used to reach the disc space. This surgery is planned not only to relieve nerve compression but also to more permanently control disc collapse, instability, or recurrent disc problems in the segment. It particularly comes into consideration in selected patients where removing only the disc material would be insufficient and mechanical pain and movement-related lumbar symptoms are prominent.

Benefits

• Helps restore disc space support and may partially restore collapsed segment height
• Along with relieving nerve compression, it reduces movement of the unstable segment, targeting more durable relief
• In situations such as lumbar spondylolisthesis, recurrent disc herniation, or disc collapse, it can offer a stronger structural solution compared to discectomy alone
• When applied with correct indications, it can provide significant clinical improvement in both leg pain and mechanical back pain

Treatment Process

Before surgery, MRI, CT, or dynamic films determine which level has instability, disc collapse, or nerve compression. The procedure is performed under general anesthesia. After approaching the problem level posteriorly, disc material is cleaned and, if necessary, nerve and canal decompression is performed. The disc space is then prepared and a cage filled with bone graft is placed into it. PLIF technique may involve bilateral posterior access to the disc space, while TLIF technique more often uses a unilateral transforaminal corridor; in modern practice, TLIF is often considered more controlled and safer. Although this slug screw-plate represents interbody fusion without plate addition, the actual surgical plan is most often determined by evaluating whether the patient's biomechanics require additional stabilization.

When is it used?

• Grade I-II lumbar spondylolisthesis with accompanying pain or nerve compression
• Patients with instability or significant disc space collapse following recurrent disc herniation
• Situations where foraminal stenosis combined with disc height loss causes nerve compression
• Selected degenerative disc disease cases with mechanical back pain where decompression alone would be insufficient

Recovery and planning

Recovery after PLIF/TLIF is planned to be longer than simple disc surgeries because the goal is not only decompression but a controlled fusion process. Patients are typically mobilized within 1-2 days after surgery. Back stiffness, surgical site pain, and movement restriction may be expected in the first weeks. A brace may be recommended in some patients; this decision is made based on the extent of surgery and bone quality. Like all surgeries, this procedure carries its own risks; fusion failure (pseudarthrosis) and subsequent stress on adjacent segments can be mentioned among them. While return to desk work typically ranges from several weeks to a few months, complete biological fusion is a longer process requiring radiological follow-up. Factors such as smoking, osteoporosis, diabetes, and obesity can negatively affect fusion, so the postoperative plan is managed not only for wound healing but for fusion success.