Your personal guide to Posterior Lumbar Interbody Fusion (PLIF)

Surgery :: Microdiscectomy :: Anterior Cervical Decompression Fusion
Disc Replacement (Pro Disc)
Intra Discal Electro Thermal Annulaplasty (IDETA)

Following your consultation with Dr Diwan it has been decided that the best plan of action is for you to under go a Posterior Lumbar interbody fusion (PLIF).  This is a moderately large surgical procedure that will take around 3 hours and will require a general anaesthetic.  The PLIF technique requires an incision in your back that allows for careful exposure and remove of the disc material at the level/s to be fused.  The placement of bone graft and /or cage into the disc space is designed to maintain the height of the previously existing disc and begin the fusion process.

 To ensure complete stabilization of your spine the fusion is supplemented with pedicle screw fixation.  Where the vertebral body is held using bone graft / cage technique, the middle and back of your spine is held in place with a screw and rod matrix.  The combination of these two techniques, complete a 360 degree fusion which creates a rigid segment that is a favourable environment for successful fusion to occur.

Preoperative instructions

• Smoking is prohibited for 4 leeks before your operation and 6 weeks after surgery.  Research suggests that smoking decreases new capillary growth under the incision line which in turn slows the healing process.
• Alcohol should be limited as much as possible 1 week before your surgery.
• Make sure you have been fitted properly with a back brace.

2 weeks before

• The following medications should be discontinued 2 weeks before your surgery as the blood thinning agents in them can accentuate swelling and discomfort.  The following non steroidal anti inflammatory drugs such as: Disprin  Naprogesic, Feldine, Voltaren, Tagamet, Neurofen. If you have any questions regarding medications please ask Dr Diwan or your anaesthetist.

Discontinue the use of natural remedies such as: Vitamin E, Evening primrose oil, Herbal tea, Green tea,

If you need pain relief in this period: Panadol, Panadine or Panadine Forte.

1 week before 

• Plan, cook and freeze meals for a week so you do not have to cook following your surgery.
• Arrange a support person to be with you on your first day at home.  If this is not possible you will need to organise transport home from the hospital at least.
• Co ordinate with the hospital admission office your admission status for your stay.

2 days before

• Cut finger nails and toe nails, remove any nail polish.
• Pay any bills that are due in the next week or 2, as well as any banking matters.
• Establish a comfort zone including items such as phone, TV guide, tissues and phone book. In preparation for the first few days post surgery.
• Call hospital to confirm booking, fasting time and hospital costs.
• Call Dr Diwan’s office to confirm post operative appointment.
• Pack for hospital, include: comfortable cloths that do not have a tight waist band, slip on shoes if possible, reading material to help pass the time before your operation.

1 day before

• Fast from specified time given to you by the hospital.
• Ensure you have all your relevant phone numbers
• Remove any obstacles in your home that you could fall over.
• Remember any X-Rays and CT scans that Dr Diwan does not already have.

Day of surgery

• Do not eat anything unless you have been instructed by the hospital.
• When you have a shower pay special attention to your back and groin area.  You may wish to wash your hair as it may be a few days before you feel up to washing it again.
• Leave home in plenty of time
• Take phone numbers of your support person.
• Remember to take your Medicare card as well as your private insurance details if applicable.
• If you are allergic to anything please remember to tell the anaesthetist.

What to expect following your surgery

Pain- From the time you wake up from the anaesthetic you should feel relief from your back / leg / arm pain.  You will however experience pain associated with the operation itself.  The recovery staff will watch you closely and ensure that pain relief is available to you if you need it.

tingling- you may experience some tingling and or numbness following your surgery this will subside over the next few days. 

Calf stimulators- You will wake up with compression (massage) devices on your calves.  These will stay on your legs until you are up walking to reduce the risk of deep vein thrombosis (DVT).

Urinary Catheter- It is necessary for you to have a catheter while you are asleep.  This will be removed once you are up and about.  Removal is not painful and takes about 2 seconds.

Coping with the blues- It is not uncommon for patients to feel a little low 1-2 days after the surgery.  This phenomenon is due to the drugs used in the anaesthetic as well as the natural let down feeling that people experience after meeting a long term goal, for example, your back surgery.  

Length of stay-  Expect to be in hospital for 3-4 days.  This can vary a little depending on the how you feel and the extensive nature of the operation.

Postoperative instructions

Week 1

• Do not bend at the waist, if you have to bend make shore it is from the hips and knees.
• Rest and eat well to regain your strength.
• Try to maintain good posture
• If you have been prescribed a brace to wear, it is very important to wear it at all times. You may remove it to bathe.
• Do not lift anything heavier than a bag of sugar.
• If you experience significant pain along with a high temperature and the shivers you should contact the hospital or Dr Diwan.
• Take your pain medication as directed.

Week 2

• Continue to wear your brace as instructed.
• Begin mobilizing gently.
• Begin gentle walking for up to 20 minutes at a time.
• Ensure you keep your first appointment with Dr Diwan on day 10. At this appointment you will be given further instructions as to your rehabilitation.

Commonly asked questions

When do I see Dr Diwan?

You will seen in Dr Diwan’s rooms on day 10 following your surgery and again at week 6 to make sure every thing is going well.

When can I have a Shower?

You can have a shower the day following your surgery with the help of a nurse.

If your dressing gets very wet just gently pat it dry with a towel do not rub it.

Do I have Stitches to come out?

You will have a drain in your back over night that will be removed the following day.  The stitches are under your skin so removal is not necessary.  When you see Dr Diwan at day 10 your dressing will be removed and the incision line cleaned.

Is there a certain position that I should be in to sleep at night?

The most important thing is for you to be comfortable.  The ideal position is lying on your back with a pillow under your knees.  This however is not compulsory, if lying on your side is more comfortable do so.

How long is it before I can drive a car?

The recommendation is to wait 6 weeks before driving a car.  At first only for short periods at a time then as you feel more comfortable you can increase the driving time.

When can I go back to work?

This is assessed on an individual bases.  To generalize a physically demanding job may take 3-4 months, where a less physically demanding job will take less time.

When is it safe to engage in sexual relations following the surgery?

This is a very personal issue and is up to you and your partner as to when you feel ready.  Clinically a 4 week period is recommended before resuming sexual activity providing you are the less active partner. There after such activity has to be in keeping with the above guidelines.     

When is it safe to lift / bend / twist at the waist?

Bending from the waist is not recommended for 6 weeks. Lifting anything greater than 5-7 kg is not recommended for 3 months and twisting is ok as long as it is done in a controlled manner at all times.