PLDF (Posterior Lumbar Decompression and Fusion)

Overview

PLDF — Posterior Lumbar Decompression and Fusion — combines a laminectomy (removing the bony roof of the spinal canal) with instrumented spinal fusion using pedicle screws and rods. It is designed for patients who have both neural compression (spinal stenosis) and spinal instability (spondylolisthesis, degenerative scoliosis, or post-decompression instability). The laminectomy gives the compressed nerves room, instantly relieving leg pain, numbness, and heaviness. The fusion stabilizes the spine to prevent recurrence of symptoms and progression of deformity. Dr. Basques may also perform a concurrent TLIF (interbody fusion) if anterior column support is needed. PLDF is one of the most versatile procedures in spine surgery — capable of addressing multiple levels of stenosis and instability simultaneously.

How It Works

Under general anesthesia, the patient is positioned face-down. A midline incision is made in the lower back. The paraspinal muscles are elevated to expose the laminae, facet joints, and transverse processes at all levels to be treated. Dr. Basques performs a complete laminectomy — removing the laminae and thickened ligamentum flavum — to decompress the central canal and nerve roots. Foraminotomies enlarge the openings where individual nerves exit. If an interbody fusion (TLIF) is needed, one facet joint is removed for cage placement. Pedicle screws are then placed at each instrumented level. Titanium rods are contoured to maintain or restore lumbar lordosis. Bone graft is applied along the decorticated transverse processes and facet remnants. The incision is closed in layers over a drain. The procedure takes 3–5 hours depending on the number of levels.

Benefits

Who Is a Candidate?

Ideal candidates have lumbar spinal stenosis with instability (degenerative spondylolisthesis, degenerative scoliosis), foraminal stenosis with mechanical back pain, or severe multi-level stenosis where decompression alone would risk post-operative instability. The classic patient is one with neurogenic claudication (leg pain and heaviness with walking that improves with sitting) plus mechanical low back pain. Dr. Basques evaluates standing X-rays (including flexion/extension) to confirm instability and MRI to assess stenosis severity.

Recovery & Aftercare

Hospital stay is typically 2–4 days. Walking begins on post-operative day 1 with physical therapy. Light activities resume after 3–4 weeks. Return to desk work is typically 6–8 weeks. Heavy labor requires 4–6 months. No heavy lifting or bending for the first 8–12 weeks. Physical therapy continues for 3–6 months. Fusion solidifies over 6–12 months. Dr. Basques provides a comprehensive recovery plan.

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