Indications for Spinal Surgery

One of the most difficult jobs of a spinal surgeon is deciding when surgical intervention is appropriate. There are five basic reasons to offer surgical treatment to patients with spinal disorders. Neurologic dysfunction (pinched nerve), Structural instability, Pathologic lesions (such as tumor or infection) Deformity or abnormal alignment Pain

Placing patients in one or more of the five categories allows the spinal surgeon to organize his/her thoughts. In general, nonoperative treatments should be considered first prior to surgical intervention. All of the groups can be managed nonoperatively or operatively. Once all conservative measures have been exhausted over a reasonable period of time, then surgical intervention may be appropriate. In general, minimally invasive endoscopic techniques are considered prior to more extensive reconstructive procedures.

Indications for PLIF What is a PLIF?
A spinal fusion that is performed from the back, by placing bone or cages within the disc space. Indications for performing a posterior lumbar interbody fusion (PLIF) can be extrapolated from the five basic indications for surgery of the spine patient. Deformity: A PLIF should be considered as an option in the surgical treatment of a painful motion segment adjacent to a long scoliosis fusion.

Instability 
In the case of spondylolisthesis, grades I and II, PLIF can be considered. For grades III and IV, PLIF is usually indicated only as an adjunctive surgical intervention when partial or complete reduction of the slip can be achieved. Additionally, it may also be used as an adjunct to the surgical treatment of certain types of fractures or dislocations.

Neural compression
A PLIF may be used as a surgical intervention in certain situations with neural compromise such as recurrent disc herniation with radiculopathy, neurogenic claudication, spinal stenosis or cauda equina syndrome, especially if low back pain is also a predominant symptom. One must realize however, that the primary surgical procedure for neural compression is decompression by laminectomy, laminotomy, foraminotomy, or discectomy.

Pathologic lesions 
A PLIF is often not needed in tumor cases and only occasionally used in infection.

Pain
This is the most common indication for a PLIF. It can be used in the surgical treatment of symptomatic spondylosis and/or symptomatic degenerative disc disease. To demonstrate the painful, degenerative level(s), MRI in conjunction with confirmatory discography is recommended.

Additionally, PLIF can be used for the treatment of pseudoarthrosis.