Significantly Improved Outcomes With a Less Invasive Posterior Lumbar Interbody Fusion Incorporating Total Facetectomy

Abstract

Clinical outcomes were significantly improved after both ST-PLIF and LI-PLIF. However, outcomes were significantly better after LI-PLIF than after ST-PLIF. Significantly shortened hospital stay with LI-PLIF probably reflected the "less invasive" technique per se. Significantly better clinical outcomes with fewer complications after LI-PLIF, however, potentially reflected maneuvers singular to LI-PLIF: (1) preservation of posterior elements, (2) avoidance of far lateral dissection over the transverse processes, (3) bilateral total facetectomy, (4) fewer neurologic complications, and (5) avoidance of iliac crest autograft. LI-PLIF is therefore recommended over ST-PLIF.

Surgical outcomes of additional posterior lumbar interbody fusion for adjacent segment disease after single-level posterior lumbar interbody fusion

“…Successful bone union was achieved in all the 18 patients at the final follow-up. The mean modified JOA score had improved from 7.7 (4-11) just prior to repeat PLIF to 11.4 (7)(8)(9)(10)(11)(12)(13)(14)(15) at the time of the maximum recovery and had slightly declined to 10.2 (5-13) at the final follow-up. The duration between repeat PLIF and the latest date of the maximum recovery was 30 (3-60) months.…”

“…Many authors have reported excellent clinical outcomes as well as high fusion rates after PLIF [10,11], indicating that PLIF is an appropriate procedure for treating an abnormal mobile segment. Although transforaminal lumbar interbody fusion (TLIF) is also reported to produce high fusion rate and excellent clinical outcomes [18,19], the additional fusion needs enough rigidity because of more stress by the longer lever arm.…”

“…Fusion is necessary to eliminate abnormal mechanical changes in the adjacent segment induced by previous lumbar fusion and destabilization caused by an additional decompression procedure itself. Among lumbar fusion techniques, the instrumented PLIF procedure achieves the decompression of traversing nerves and the cauda equina as well as the exiting nerve root of the affected segment and results in the highest fusion rate and excellent clinical results [10][11][12].…”

Minimally invasive surgery compared to open spinal fusion for the treatment of degenerative lumbar spine pathologies

“…[3][4][5][6][7][8][9][10][11][12] The current trend favours minimally invasive surgery (MIS) of the spine due to lower complication rates and approach-related morbidity with minimal soft tissue trauma, reduced intraoperative blood loss and risk of transfusion, improved cosmesis, decreased postoperative pain and narcotic usage, shorter hospital stays, earlier mobilisation with faster return to work and thus reduced overall health care costs. 1,4,[6][7][8][9][13][14][15][16][17][18] However, to our knowledge there is no quality published articles showing that MIS is superior to open spinal surgery. The aim of this study was to directly compare the effectiveness of MIS to conventional open spinal fusion, by assessing clinical outcomes and patient satisfaction.…”

“…These were confirmed by dynamic radiographs, CT scans and MRI. The average follow-up time following MIS procedures was approximately 11.5 months (range: 5.40-20.10 months) in comparison to 18 Table, Orthopedic Systems, Union City, CA, USA) was used. A posterior lumbar interbody fusion (PLIF) graft was inserted via a small (3-5 cm) midline incision over the disc space to be fused (Fig.…”