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Posterior Lumbar Interbody Fusion
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Pre-Procedure

      • Outcomes

        TERMINOLOGY

        • Definitions

          • Posterior lumbar interbody fusion (PLIF)
            • Operation with exploration of disc space from posterior approach, with fusion by grafting of disc space
              • PLIF advantages
                • Decompresses canal directly
                • Rigidly stabilizes the spine with posterior instrumentation
                • Better for > 3-level disease than anterior lumbar interbody fusion (ALIF)
                • Deformity correction increased by resection of posterior elements
                • Low risk to great vessels such as iliac artery and common iliac veins
                • Very low risk of sympathic plexus injury
              • Disadvantages relative to ALIF
                • Increased risk of dural tear
                • Increased risk of root injury
          • Transforaminal lumbar interbody fusion (TLIF)
            • Anterior lumbar interbody fusion via transforaminal posterior approach
              • TLIF advantages
                • Only ipsilateral foramen is exposed
                • Exposure and retraction of thecal sac minimal
                • Preservation of posterior column integrity

        PRE-PROCEDURE

        • Indications

          • Pre-Procedure Imaging

            PROCEDURE

            • Procedure Steps

              • Alternative Procedures/Therapies

                POST-PROCEDURE

                • Expected Outcome

                  OUTCOMES

                  • Complications

                    Selected References

                    1. Mroz TE et al: Complications related to osteobiologics use in spine surgery: a systematic review. Spine (Phila Pa 1976). 35(9 Suppl):S86-104, 2010
                    2. Agarwal R et al: Osteoinductive bone graft substitutes for lumbar fusion: a systematic review. J Neurosurg Spine. 11(6):729-40, 2009
                    3. Valdes MA et al: Recombinant bone morphogenic protein-2 in orthopaedic surgery: a review. Arch Orthop Trauma Surg. 129(12):1651-7, 2009
                    4. Benglis D et al: A comprehensive review of the safety profile of bone morphogenetic protein in spine surgery. Neurosurgery. 62(5 Suppl 2):ONS423-31; discussion ONS431, 2008
                    5. Wong DA et al: Neurologic impairment from ectopic bone in the lumbar canal: a potential complication of off-label PLIF/TLIF use of bone morphogenetic protein-2 (BMP-2). Spine J. 8(6):1011-8, 2008
                    6. Joseph V et al: Heterotopic bone formation with the use of rhBMP2 in posterior minimal access interbody fusion: a CT analysis. Spine (Phila Pa 1976). 32(25):2885-90, 2007
                    7. McKay WF et al: A comprehensive clinical review of recombinant human bone morphogenetic protein-2 (INFUSE Bone Graft). Int Orthop. 31(6):729-34, 2007
                    8. Haid RW Jr et al: Posterior lumbar interbody fusion using recombinant human bone morphogenetic protein type 2 with cylindrical interbody cages. Spine J. 4(5):527-38; discussion 538-9, 2004
                    9. Hodges SD et al: Intraoperative loosening of Bagby and Kuslich cages during anterior lumbar interbody fusion. J Spinal Disord. 13(6):535-7, 2000
                    10. Kuslich SD et al: Four-year follow-up results of lumbar spine arthrodesis using the Bagby and Kuslich lumbar fusion cage. Spine (Phila Pa 1976). 25(20):2656-62, 2000
                    11. Bagby G: The Bagby and Kuslich (BAK) method of lumbar interbody fusion. Spine (Phila Pa 1976). 24(17):1857, 1999
                    12. Rajaraman V et al: Visceral and vascular complications resulting from anterior lumbar interbody fusion. J Neurosurg. 91(1 Suppl):60-4, 1999
                    13. Kuslich SD et al: The Bagby and Kuslich method of lumbar interbody fusion. History, techniques, and 2-year follow-up results of a United States prospective, multicenter trial. Spine (Phila Pa 1976). 23(11):1267-78; discussion 1279, 1998
                    Related Anatomy
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                    Related Differential Diagnoses
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                    References
                    Tables

                    Tables

                    KEY FACTS

                    • Terminology

                      • Pre-Procedure

                        • Outcomes

                          TERMINOLOGY

                          • Definitions

                            • Posterior lumbar interbody fusion (PLIF)
                              • Operation with exploration of disc space from posterior approach, with fusion by grafting of disc space
                                • PLIF advantages
                                  • Decompresses canal directly
                                  • Rigidly stabilizes the spine with posterior instrumentation
                                  • Better for > 3-level disease than anterior lumbar interbody fusion (ALIF)
                                  • Deformity correction increased by resection of posterior elements
                                  • Low risk to great vessels such as iliac artery and common iliac veins
                                  • Very low risk of sympathic plexus injury
                                • Disadvantages relative to ALIF
                                  • Increased risk of dural tear
                                  • Increased risk of root injury
                            • Transforaminal lumbar interbody fusion (TLIF)
                              • Anterior lumbar interbody fusion via transforaminal posterior approach
                                • TLIF advantages
                                  • Only ipsilateral foramen is exposed
                                  • Exposure and retraction of thecal sac minimal
                                  • Preservation of posterior column integrity

                          PRE-PROCEDURE

                          • Indications

                            • Pre-Procedure Imaging

                              PROCEDURE

                              • Procedure Steps

                                • Alternative Procedures/Therapies

                                  POST-PROCEDURE

                                  • Expected Outcome

                                    OUTCOMES

                                    • Complications

                                      Selected References

                                      1. Mroz TE et al: Complications related to osteobiologics use in spine surgery: a systematic review. Spine (Phila Pa 1976). 35(9 Suppl):S86-104, 2010
                                      2. Agarwal R et al: Osteoinductive bone graft substitutes for lumbar fusion: a systematic review. J Neurosurg Spine. 11(6):729-40, 2009
                                      3. Valdes MA et al: Recombinant bone morphogenic protein-2 in orthopaedic surgery: a review. Arch Orthop Trauma Surg. 129(12):1651-7, 2009
                                      4. Benglis D et al: A comprehensive review of the safety profile of bone morphogenetic protein in spine surgery. Neurosurgery. 62(5 Suppl 2):ONS423-31; discussion ONS431, 2008
                                      5. Wong DA et al: Neurologic impairment from ectopic bone in the lumbar canal: a potential complication of off-label PLIF/TLIF use of bone morphogenetic protein-2 (BMP-2). Spine J. 8(6):1011-8, 2008
                                      6. Joseph V et al: Heterotopic bone formation with the use of rhBMP2 in posterior minimal access interbody fusion: a CT analysis. Spine (Phila Pa 1976). 32(25):2885-90, 2007
                                      7. McKay WF et al: A comprehensive clinical review of recombinant human bone morphogenetic protein-2 (INFUSE Bone Graft). Int Orthop. 31(6):729-34, 2007
                                      8. Haid RW Jr et al: Posterior lumbar interbody fusion using recombinant human bone morphogenetic protein type 2 with cylindrical interbody cages. Spine J. 4(5):527-38; discussion 538-9, 2004
                                      9. Hodges SD et al: Intraoperative loosening of Bagby and Kuslich cages during anterior lumbar interbody fusion. J Spinal Disord. 13(6):535-7, 2000
                                      10. Kuslich SD et al: Four-year follow-up results of lumbar spine arthrodesis using the Bagby and Kuslich lumbar fusion cage. Spine (Phila Pa 1976). 25(20):2656-62, 2000
                                      11. Bagby G: The Bagby and Kuslich (BAK) method of lumbar interbody fusion. Spine (Phila Pa 1976). 24(17):1857, 1999
                                      12. Rajaraman V et al: Visceral and vascular complications resulting from anterior lumbar interbody fusion. J Neurosurg. 91(1 Suppl):60-4, 1999
                                      13. Kuslich SD et al: The Bagby and Kuslich method of lumbar interbody fusion. History, techniques, and 2-year follow-up results of a United States prospective, multicenter trial. Spine (Phila Pa 1976). 23(11):1267-78; discussion 1279, 1998