Lumbar Interbody Fusion (TLIF/PLIF)
Lumbar interbody fusion is a stabilization surgery in which a cage and bone graft are placed into the disc space between two lumbar vertebrae to permanently fuse the level. TLIF and PLIF are two common variants that reach the disc space from the back and are supported with pedicle screws.
最后更新: 2026-06-08
Definition
Interbody fusion permanently stabilizes a mobile spinal segment by placing graft and a cage into the disc space to achieve bony fusion. PLIF (posterior lumbar interbody fusion) reaches the disc space from both sides of the midline, alongside the dural sac; TLIF (transforaminal lumbar interbody fusion) approaches unilaterally through the foramen with less retraction of the neural structures. Both are usually combined with posterior instrumentation using pedicle screws and rods; in this respect they differ from decompression-only techniques such as laminectomy.
Indications
Fusion is considered when stabilization of the segment is required: degenerative or isthmic spondylolisthesis, segmental instability, selected mechanical back pain from marked degenerative disc disease, anticipated instability after decompression, and some deformity or recurrent cases. The decision rests on correlation of clinical findings with imaging, evidence of instability and failure of conservative treatment. In simple stenosis where decompression alone may suffice, routine fusion is not always necessary.
Procedure
The procedure is performed under general anesthesia in the prone position. Through a posterior approach the level is exposed, the necessary decompression (laminectomy/laminotomy, facet resection) is carried out, and the disc material is removed while the endplates are prepared for the graft bed. Bone graft and a cage of appropriate height are placed in the disc space to support disc height and lordosis; the segment is stabilized with pedicle screws and rods. TLIF uses a unilateral transforaminal corridor and PLIF a bilateral posterior corridor; minimally invasive variants (MIS-TLIF) have been described. Bony fusion develops over weeks to months.
Advantages and Limitations
Interbody fusion provides anterior column support and can offer stabilization and indirect decompression in unstable or slipped segments; TLIF is preferred in many centers because of its potential for less nerve root retraction. In contrast, fusion is a larger procedure than decompression, with longer operative time, more blood loss and a higher chance of implant-related issues. Non-union (pseudarthrosis), implant loosening and adjacent-segment degeneration over time are possible. Not every instance of instability or back pain requires fusion; the indication is assessed carefully to avoid unnecessary fusion.
Recovery and Risks
Recovery and maturation of the fusion vary by patient, number of levels and technique, and may extend from weeks to months. Possible risks include infection, dural tear and CSF leak, nerve injury, bleeding, screw or cage malposition, non-union and adjacent-segment disease. Complete resolution of pain and function cannot be expected in every patient. No outcome is guaranteed; the decision is made individually by considering the patient's clinical status together with imaging findings.
参考文献
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1802.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:3083.
- Mobbs RJ, et al. Lumbar interbody fusion: techniques, indications and comparison (ALIF, PLIF, TLIF, LLIF). J Spine Surg. 2015.
本文仅供一般参考，不能替代医疗检查。诊断与治疗决策因人而异。