Posterior Lumbar Interbody Fusion (PLIF): Everything You Need to Know

Spine surgery


“PLIF” stands for “Posterior Lumbar Interbody Fusion.” It is a surgical procedure used to treat spinal instability or other conditions that cause pain or nerve compression in the lower back. In a PLIF procedure, a surgeon removes the damaged or diseased disc from between two vertebrae in the lower back and replaces it with a bone graft or synthetic material. The surgeon then places screws and rods into the vertebrae to stabilize the spine and promote fusion of the bone graft with the adjacent vertebrae. The goal of a PLIF is to help alleviate pain and improve spinal stability. PLIF surgery is performed under general anesthesia and may require a hospital stay of several days and have a recovery time of several weeks to months. 

First of all, what is a fusion surgery?

Spinal fusion surgery is a procedure that involves joining two or more vertebrae together in the spine. This is typically done to alleviate pain caused by conditions such as spondylolisthesis, scoliosis, or spinal fractures. During the surgery, the surgeon will use bone grafts and/or metal hardware (such as screws and rods) to hold the vertebrae in place while they fuse together during the healing process. The goal of the surgery is to stabilize the spine and reduce pain and nerve compression.

What are the different types of spinal fusion, and how is PLIF different?

There are several different types of spinal fusion surgeries for the back, each with their own unique approach and techniques. Some of the most common types of spinal fusion surgeries:

  • Posterior Lumbar Interbody Fusion (PLIF): In this procedure, the surgeon accesses the spine from the back of the body
  • Anterior Lumbar Interbody Fusion (ALIF): In this procedure, the surgeon accesses the spine from the front of the body
  • Transforaminal Lumbar Interbody Fusion (TLIF): In this procedure, the surgeon accesses the spine from the side (through the neural foramina)
  • Lateral Lumbar Interbody Fusion (LLIF): In this procedure, the surgeon accesses the spine from the side

PLIF is a type of spinal fusion that is performed from the posterior (back) of the body. 

Which conditions can be treated with a PLIF?

Spinal fusion surgery is typically indicated for conditions that cause pain or instability in the spine. Some common indications for the surgery include:

  • Degenerative disc disease: This is a condition in which the discs between the vertebrae begin to wear down, leading to pain and instability in the spine.
  • Spinal fractures: Fractures in the vertebrae can cause instability and pain in the spine.
  • Spondylolisthesis: This is a condition in which one vertebra slips forward over another, which can lead to instability, nerve compression and pain.
  • Scoliosis: This is a condition in which the spine is curved to one side. This can lead to uneven pressure on the vertebrae and cause pain. A fusion surgery is often used to correct the deformity from scoliosis. 
  • Tumors: Spinal tumors can cause pain and instability, especially if they erode through vertebrae. 
  • Instability from Surgery: A fusion surgery is sometimes needed to stabilize the spine after a decompression surgery such as a laminectomy

When is a PLIF used over other types of fusion surgery?

PLIF may be preferred over other types of spinal fusion surgery in the following situations:

  • When there is significant disc degeneration or instability at multiple levels of the spine, as PLIF can address multiple levels of the spine in a single procedure.
  • When a surgeon wants to access the intervertebral disc space through a posterior approach.
  • When the spinal nerves are compressed from both the front and back of the spinal canal, as PLIF can help address both sources of compression.
  • When a patient has had a previous spinal surgery and needs revision surgery, as PLIF can provide better access to the affected area from a posterior approach.

What actually happens during a PLIF surgery?

A PLIF surgery typically takes several hours to complete and is performed under general anesthesia. Here is a general overview of what can be expected during the surgery:

  1. Incision: The surgeon makes an incision in the patient’s back, exposing the affected area of the spine.
  2. Removal of the damaged disc: The surgeon removes the damaged or diseased disc from between the vertebrae, decompressing any nerves that may have been compressed by the damaged disc.
  3. Placement of the bone graft or synthetic material: The surgeon places a bone graft or synthetic material into the space between the vertebrae where the damaged disc was removed. This bone graft or synthetic material, will help promote new bone growth and fusion of the vertebrae.
  4. Placement of screws and rods: The surgeon places screws and rods into the vertebrae to provide additional support and stability to the spine. The screws and rods are typically made of titanium or a similar material that is biocompatible with the body.
  5. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied to the wound.

After the surgery, the patient will be taken to a recovery room to allow the anesthesia to wear off. Most patients will spend several days in the hospital after the surgery to ensure a safe recovery. 

What is the recovery time following a PLIF?

In most cases, you can expect to spend 1 to 3 days in the hospital following a fusion surgery.  The duration of your stay will depend on your level of pain control and your ability to move around.

It is common for patients to begin standing and walking the day after surgery. Your surgeon may give you a back brace to help you feel more comfortable and to protect the surgical fusion.

During the first several weeks after the surgery, you should be able to perform basic exercises like walking but should avoid activities such as bending, twisting, or lifting heavy objects during this time.

Most patients who undergo a fusion procedure should expect to gradually resume their normal activities over a period of several months.

What are the risks of a PLIF?

As with any complex operation, there are several risks associated with spinal fusion surgery. Some of these risks include:

  • Infection: Although surgery is performed in sterile conditions, there is always a small risk of infection at the surgical site. 
  • Nerve damage: Nerves in and around the spinal cord can be damaged during the surgery.
  • Damage to other surrounding tissues: Other tissues as well as blood vessels and organs can be damaged during the procedure.
  • Non-union: The vertebrae may not fuse together properly, which may require additional surgery.
  • Adjacent segment disease: Adjacent segment disease can occur when the segments of the spine above or below the fused area become damaged or degenerate.
  • Hardware complications: There is a risk that the hardware used to fuse the vertebrae together may become loose or cause irritation.

Is a PLIF right for me?

It’s important to consult with a qualified spine surgeon to determine if an PLIF is the right option for you. 

There are many factors to be considered, including the specific condition being treated, your overall health, and your goals and expectations.

It’s also important to note that spinal fusion surgery is not always the best option for everyone. Some patients may be better served by other treatments, such as physical therapy, medications, or minimally invasive procedures.

About the Author

Dave Harrison, MD

Dr. Harrison is a board certified Emergency Physician with a part time appointment at San Francisco General Medical Center and is an Assistant Clinical Professor-Volunteer at the UCSF School of Medicine. Dr. Harrison attended medical school at Tufts University and completed his Emergency Medicine residency at the University of Southern California. Dr. Harrison manages the editorial process for