Posterior Lumbar Decompression and Fusion (PLDF)
Below are some of the most common questions we receive from patients who are considering proceeding with a Posterior Lumbar Decompression and Fusion. Please keep in mind that the recovery from surgery is quite subjective and is affected by various factors such as patient age, comorbid illnesses, degree of spinal cord or nerve impingement, the length of illness prior to surgery as well as degree of disability prior to surgery to name a few. The answers below are based on the average patient that we see.
What Is Posterior Lumbar Decompression And Fusion (PLDF)?
Posterior lumbar decompression and fusion (PLDF) is a surgical procedure that aims to relieve pain and pressure on the spinal cord and the nerves in the lower back. The lower back is made up of the lumbar spine, where the spine curves inward toward the abdomen. It consists of the five vertebrae, L1-L5. They end in the sacral region, which connects the lumbar spine with the tailbone. Because they bear the most weight, the lowest two vertebrae in the lumbar spine, L4 and L5, are most prone to degradation and injury and are the most often fused.
Lower Back Pain Causes
Lower back pain and pressure is often caused by lumbar spinal stenosis, which is often created by spondylolisthesis, a slippage of a spinal disc, or degenerative changes. When this happens, the disc pushes on nearby nerve roots and causes lower back pain and pain that can radiate down into the legs. Fusion may be needed to stabilize the spine, as the motion and degenerative changes can continue to irritate the nerve roots and continue to cause back and leg pain.
Degenerative disk disease in the lumbar spine can also be the cause of lower back pain and pressure. Because spinal discs do not have a blood supply, if a disc is injured due to wear and tear or a traumatic injury, it cannot repair itself. Degenerative disc disease affects nearly one third of people between 30 and 50 years of age, although the degeneration may not be bad enough to lead to pain and future fusion surgery. If the outer portion of the disc breaks down, the inner gel-like portion of the disc can leak out and irritate nearby nerves. In some cases, the disc collapses enough to compress a nerve root. If this leads to chronic, debilitating pain, decompression and fusion surgery may be necessary.
Am I a Candidate for PLDF?
Dr. Albert’s first treatment options for lower back pain are nonsurgical. These include physical therapy, epidural steroid injections, anti-inflammatory medications, and other treatments. However, if these treatments are not effective, if your symptoms worsen, or if nerves are being impacted to the degree where there is numbness, tingling, and possible leg weakness, PDLF can be the best option for relieving the pain.
Decompression and Fusion Surgery Benefits
Posterior lumbar decompression and fusion is performed to relieve chronic, debilitating pain and pressure on the spinal cord and the nerves in the lower back. By limiting movement of the vertebrae causing the pain, and by removing disc material and areas of the vertebrae that are impinging on nearby nerves, the pain is usually relieved. For patients who have tried various nonsurgical alternatives and still have chronic pain, this surgery can return quality of life.
There are two major parts of this spinal fusion. The first being the bony portion of the fusion. This consists of a combination of bone from the bone bank and local bone from the area of the spinal decompression. In a majority of cases, Dr. Albert does not take a bone graft from the patient’s iliac crest (hip area), which means you will not have a separate incision. Bone growth is stimulated and then the grafts are put into place. This fuses the vertebrae and stops the painful movement in the area. The second component of the fusion is the instrumentation. The instrumentation may be rods and screws and/or a cage that is placed between the vertebrae.
Is PLDF Surgery painful?
Please keep in mind that pain is a very subjective experience and one’s reaction to surgery is affected by a variety of factors as mentioned above. It is not uncommon for patients to experience “reminder” pain after surgery. This is when a patient begins to experience the same symptoms as they had before surgery. While this is common in recovery from spine surgery we understand that this can be very concerning to our patients. We encourage you to call the office with any concerns you may have after surgery.
What to avoid Before Or After Surgery
We ask that you refrain from taking any non-steroidal anti-inflammatory medicines 10 days before your surgery and 10 weeks after surgery such as:
- Aspirin, Advil, & Aleve
- Herbal Supplements
- Vitamins E & K
- Fish oil
If you have another treating physician who recommends that you do not stop Aspirin prior to surgery please be sure to discuss this with our office. You should discontinue all exposure to nicotine, as well as nicotine-containing products, two weeks before and at least 6 weeks after your surgery.
PLDF Surgery Risks
The principal risk for this lumbar fusion surgery is that a solid fusion won’t build between the fused vertebrae. However, fusion success rates for this surgery are high, ranging from 90-95 percent. The odds of an unsuccessful fusion rise with patients who smoke, are obese, have had multiple level fusion surgery, or have been treated with radiation for cancer.
As with any surgery, there are risks of infection and bleeding. These complications are uncommon with this procedure (1-3 percent of cases). There is also the small risk that the fusion won’t alleviate the pain.
Dr. Albert is without a doubt, the most gifted, competent and skilled spinal surgeon a patient could ask for. He is truly warm, compassionate, responsive to the needs of his patients and very caring. Clearly, I have total confidence and trust in Dr. Albert, and he is a credit to the Hospital for Special Surgery.
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The first visit to Dr. Alberts is around 3 weeks after surgery. However, if you have any questions or concerns prior to your first post-op visit, please call the office. After speaking with you, if we believe we should see you in the office we will schedule an earlier appointment. Outpatient Physical Therapy will be necessary. You may use any facility or therapist whom you feel comfortable working with.
Most patients do not have sutures that require removal after a Posterior Lumbar Decompression and Fusion Surgery. There are internal sutures that will dissolve with time. There may also be steri-strips (white pieces of tape) over the incision that will either fall off or we will remove them during your visit.
During the first 2-3 weeks, your activity is limited to walking and any exercises taught by the home therapist. We encourage you to walk as much as you are comfortable. During this time, you may go up and down stairs with the use of a railing. You may also sleep in a normal bed. You will be able to lift 5 pounds for the first 2-3 weeks.
After three weeks, you will be able to resume low-impact cardiovascular activities. You can also increase the amount of weight you are lifting. Within a reasonable amount of time after surgery, you will have very few restrictions on your activities. The average length of time out of work after a Posterior Lumbar Decompression and Fusion Surgery is between 4-6 weeks. Patients who perform labor intense jobs are more likely to be out of work closer to 6-8 weeks. Please be sure to discuss any specific questions with us in the office.
Frequently Asked Questions
When will I be able to drive?
Most patients are able to begin driving, short distances, between 3-4 weeks after surgery. You may be a passenger in a car as soon as you feel up to it.
How long will I be wearing the lumbar brace?
The average amount of time patients wears the brace after a PLDF is 3 weeks.
Will I set off metal detectors?
No, the titanium instrumentation does not currently set off metal detectors.
Will I be able to have I have an MRI after surgery?
Yes, the titanium instrumentation does not react to the magnet in the MRI machine. However, you should still notify the MRI facility of the presence of the instrumentation.