Failed Posterior Lumbar Interbody Fusion Information and Treatment
Spinal fusion is the surgery of choice for many different spinal conditions. Most – over 80% at last estimate – of all lumbar fusion surgeries are completed by creating incisions in the patient’s back. This is known as “PLIF,” or “Posterior Lumbar Interbody Fusion.” Many surgeons prefer this approach for a lumbar fusion, because:
- It provides easy access to the spine.
- It does not require the movement of major organs.
But while the back (posterior) may be an easy access point for surgeons, it also has the highest failure rate of lumbar fusion procedures. An estimated 10% to 40% of patients that undergo PLIF will experience some form of pain after back surgery, and if the pain is severe, it may require some type of revision spine surgery.
Why Does PLIF Fail?
Dr. Chappuis of Spine Center Atlanta explains the high failure rate of PLIF like so: “A PLIF puts the bone grafts and hardware on the back of the spine. But this is not how nature intended weight distribution on the spine. In a healthy patient the majority weight of the torso is on the front side of the spine. When a PLIF is performed and the supporting hardware is placed on the back of the spine it causes unnatural weight distribution where the weight of the upper torso is distributed posterior. This can cause unnatural wear on adjacent levels leading to more problems down the road.”
When a spine surgery is said to have “failed,” it means that some type of severe or chronic pain has returned after spinal fusion or Pseudoarthrosis has occurred. There are many different ways that this can occur. Surgical error, for example, could be the cause of PLIF, as can misdiagnosis. Some of the most frequent causes of failed PLIF include:
- Adjacent Segment Disease
- Failed Fusion/Pseudoarthrosis
- Nerve Compression
- Scar Tissue Formation/Epidural Fibrosis
- Facet Syndrome
- Pedicle Screw Failure
- Insufficient Disc Space Removal
Poor patient selection is another issue. Not all PLIF patients were good candidates for posterior lumbar fusion, but due to the simplicity of the technique, it remains a popular treatment among spine surgeons. It is possible that PLIF was simply not the right choice in surgery for the patient’s pain.
Treatment for Failed Posterior Lumbar Interbody Fusion
Failed PLIF Treatments require a thorough diagnosis to determine the cause of the pain. Failed fusion is the most common causes of PLIF, in which case a new and more effective lumbar fusion revision surgery technique may be needed. However, because “failed” PLIF encompasses all possible causes of pain after surgery, treatments for PLIF vary, and include:
- Non-Surgical Intervention (Physical Therapy, Exercise, Medication)
- Stem Cell Therapy
- Neural Decompression
- Hardware and Pedicle Screw Removal
- Spinal Cord Stimulation
- ALIF Lumbar Fusion
Surgical techniques depend on the structural changes that may have occurred as a result of the PLIF. Rest assured that, when you see a failed spine surgery expert, any surgical recommendations will be made with respect to your experience. At Spine Center Atlanta, we know how important it is for a chronic pain treatment to work, which is why all interventions and revisions are made with that in mind.
If you are struggling with pain after back surgery and are interested in learning more about the possible treatments for PLIF, please call Spine Center Atlanta today at 404-351-5812. Led by Dr. James L Chappuis, Spine Center Atlanta is a source for FBSS for patients from across the nation, known for its expertise in failed back surgery syndrome (FBSS). Contact us today for an appointment.