Posterior lumbar interbody fusion

Abstract

The greatest advantage of posterior lumbar interbody fusion (PLIF) is that it dynamically decompresses neural structures by holding the vertebral bodies apart and fusing them into a single motion segment. After ten years of experience with PLIF, the authors recommend a technique that enhances a high rate of fusion by utilizing the following four biomechanical principles: (1) preservation of the integrity of the posterior portion of the motion segment; (2) partial preservation of the integrity of the cortical end-plates; (3) attempted maximal removal of the disc material; and (4) one-piece grafts, as applied to PLIF, a "unigraft" concept, to fill all the disc space compactly with autogenous bone grafts. In a series of 465 cases of PLIF with a follow-up period of at least one year, the authors achieved a fusion rate of 88% and satisfactory clinical results in 82%. The fusion rate and clinical result are further investigated in six different clinical entities: lateral herniated disc, midline disc, degenerative disc, recurrent disc, spinal stenosis, and unstable spine. PLIF, as currently conceived, is an important technique in the surgical management of lumbar disc diseases.