A posterior lumbar interbody fusion surgery (PLIF) may reduce your pain from degenerative disc disease or lumbar spondylolisthesis. Our video walk-through can help you visualize how this procedure is performed:

See Posterior Lumbar Interbody Fusion (PLIF) Surgery

A PLIF fusion is often supplemented by a simultaneous posterolateral spine fusion surgery.
Posterior Lumbar Interbody Fusion (PLIF) Video

Video highlights

Pictured above in purple is the lower back (also known as the lumbar spine). A PLIF is most commonly performed in the L4-L5 or L5-S1 segments of the lumbar spine.

See Lumbar Spine Anatomy and Pain

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PLIF procedure

To begin the procedure, your surgeon will make a 3-to 6-inch incision in the midline of your back (shown above as a thin purple line).

Your surgeon will then lift the muscles off of your lamina (the roof of your spinal canal).

See Back Muscles and Low Back Pain

Your nerve roots are exposed as a result of removing the lamina. At this time, your surgeon may trim your facet joints to reduce any pressure on your nerve roots.

See Spinal Cord and Spinal Nerve Roots

Next, your surgeon will retract your nerve roots to one side and clear the disc space of disc material.

See Spinal Discs

Once the disc space is cleared, your surgeon will insert an implant (called a cage) into the disc space. The purpose of the implant is to restore normal spacing between your vertebrae, which will alleviate pressure on your nerve roots.

See Interbody Cages for Spine Fusion

Beginning the fusion

Next, bone graft is placed in the cage and along the sides of your spine.

See Bone Graft for Spine Fusion

If your own bone is used in the bone graft, your surgeon will perform an additional surgical procedure to harvest bone from your iliac crest (located along the back of your hip). In some cases, synthetic bone graft options or bone removed from a laminectomy may also be used.

See Bone Graft Options for Spine Fusion

To add additional support, your surgeon may add a series of rods and screws to the back of your spine. And a simultaneous posterolateral spine fusion surgery may be done to supplement the PLIF.

PLIF risks and complications

PLIF fusions rates should be as high as 90% to 95%, but the following risks and complications are associated with the surgery:

  • Nonunion. The main risk associated with a PLIF is that a solid fusion will not be obtained, which in turn requires an additional surgery. Nonunion rates are higher for people who smoke, are obese, or have been treated with radiation for cancer.
  • Infection and/or bleeding. Roughly 1% to 3% of people will experience infection and/or bleeding as a result of PLIF surgery.

See Failed Spinal Fusion Surgery

More on the dangers of smoking after surgery

Nicotine is a bone toxin, which inhibits bone-growing cells (osteoblasts). If you have any form of nicotine after spine fusion surgery—especially right after surgery—it becomes more difficult for your body to grow the bone needed for a fusion.

See Quitting Smoking Before a Spinal Fusion

The risk of a non-healing fusion is 3 times more likely if nicotine is used after surgery, and it may make your pain medication less effective.

Learn more:

Spine Fusion Risks and Complications

Additional Spinal Fusion Surgery Factors and Considerations