Lumbar Interbody Fusion: Techniques, Pearls and Pitfalls

Abstract

Lumbar interbody fusion (LIF) is an effective and popular surgical procedure for the management of various spinal pathologies, especially degenerative diseases. Currently, LIF can be performed with posterior, transforaminal, anterior, and lateral approaches by open surgery or minimally invasive surgery (MIS). Each technique has its own advantages and disadvantages. In general, posterior LIF is a well-established procedure with good fusion rates and low complication rates but is limited by the possibility of iatrogenic injury to the neural structures and paraspinal muscles. Transforaminal LIF is frequently performed using an MIS technique and has an advantage of reducing these iatrogenic injuries. Anterior LIF (ALIF) can restore the disk height and sagittal alignment but has inherent approach-related challenges such as visceral and vascular complications. Lateral LIF and oblique LIF are performed using an MIS technique and have shown postoperative outcomes similar to ALIF; however, these approaches carry a risk of injury to psoas, lumbar plexus, and vascular structures. Herein, we provide a detailed description of the surgical procedures of each LIF technique. We shall then consider the pearls and pitfalls, as well as propose surgical indications and contraindications based on the available evidence in the literatures.

Comparison of MRI Visualization Following Minimally Invasive and Open TLIF: A Retrospective Single-Center Study

“…Rigid stabilization of the spine leads to significant biomechanical changes and overload of adjacent segments, accelerating their degeneration [1,5]. In addition, classical decompression and stabilization interventions are associated with substantial damage and atrophy of the multifidus muscle, which maintains the dynamic lumbar and spinal pelvic balance [14].…”

“…Transforaminal interbody fusion (TLIF) and open (Op) dorsal rigid stabilization are the most common methods of surgical treatment for most degenerative diseases of the lumbar spine [1,2]. At the same time, minimally invasive (MI) decompression and stabilization techniques are actively used in modern spinal surgery and associated with better clinical outcomes due to less paravertebral tissue damage, minimum postoperative pain syndrome, and shorter recovery [3,4].…”

Comparison between posterior lumbar interbody fusion and transforaminal lumbar interbody fusion in the management of lumbar spondylolisthesis

“…Because the decompression alone can worsen the instability, many surgeons recommended fusion to stabilize the spine (11,12). Among spinal fusion techniques, widely accepted are TLIF and PLIF procedures, while the former lumbar interbody fusion was described as fi rst by Cloward in 1940 (13).…”

Risk factors for intraoperative endplate injury during minimally-invasive lateral lumbar interbody fusion

“…MIS-LLIF was performed, according to XLIF manner, by splitting the psoas muscle using tubular retractors and intraoperative neuromonitoring 5 . All procedures were performed in a right lateral decubitus position with the hip and knee joints flexed.…”

“…It can provide greater bone-graft contact surface and the possibility to insert more lordotic cages, improving sagittal balance 1 – 4 . However, some pitfalls of conventional ALIF exit: great vessel injury, abdominal organ injury, and incisional hernia 5 .…”