Scoliosis and Spine Associates
spine surgery

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Mission

Scoliosis & Spine Care is dedicated to The Highest Level of Care.

We treat our patients as we would treat our own family.

PLIF, ALIF and TLIF Procedures

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:

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.

 

More Spinal Information

Spinal Fusion with Instrumentation
Spondylolisthesis - Degenerative
Spondylolisthesis Overview
Minimally Invasive Spine Surgery
Bone Morphogenetic Protein (BMP) for Spinal Fusion