A minimally invasive approach for posterior lumbar interbody fusion

Despite the technical innovations that posterior approaches for lumbar fusion have undergone, the goal of a significant reduction in the extent of dissection has remained elusive. Because extensive muscular dissection is related to both acute and chronic pain, a reproducible minimally invasive posterior approach to lumbar interbody fusion would have significant clinical value. The technical aspects of a minimally invasive approach to posterior lumbar interbody fusion (microPLIF) with fixation involving tools developed for videoscopic discectomy will be described.

The technical description of this microPLIF procedure is based on experience gained in the first 38 cases. Outcomes categorized using a modified Macnab criteria are reported for 13 patients in whom 1 year or more of follow-up data were available. All procedures were completed. The section of anulus fibrosus that was exposed provided access for a thorough discectomy and endplate preparation. Outcome in 11 of the 13 patients in whom outcome data were available was excellent or good. Six of these patients returned to work between 3 and 12 weeks postoperatively. Two patients suffered complications related to insertion of the interbody device.

This procedure involves a reproducible technique that results in a construct that is radiographically identical to that which could be expected from any standard open procedure. The minimized muscular dissection results in a tremendous improvement in postoperative mobility. All complications in this series were related to the placement of femoral cortical allograft implants. The use of a modified cement restrictor should eliminate the risk of interbody device placement.