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Updated: Jan 1, 2026
Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion
Published on: June 6, 2025
Lumbar Spine Fusion Rates With Local Bone in Posterolateral and Combined Posterolateral and Interbody Approaches.
Daniel K Park1, Richard Roberts1, Paul Arnold1
1Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI (Dr. Park, Dr. Roberts, Dr. Baker, and Dr. Fischgrund); the Department of Neurosurgery, University of Kansas Hospital, Kansas City, KS (Dr. Arnold); the Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA (Dr. Kim); and Indiana Spine Center, Caramel, IN (Dr. Sasso).
Local bone graft for posterolateral lumbar fusion (PLF) showed lower fusion rates compared to the traditional autologous iliac crest bone graft (ICBG). This study evaluated local bone graft efficacy in degenerative lumbar conditions.
Area of Science:
- Spine surgery
- Orthopedic research
- Bone grafting techniques
Background:
- Pseudarthrosis remains a challenge in posterolateral lumbar fusion (PLF) for degenerative lumbar conditions.
- Autologous iliac crest bone graft (ICBG) is a traditional bone graft choice, but carries a complication rate of up to 39%.
- Utilizing local bone from laminectomy can eliminate the complications associated with ICBG harvesting.
Purpose of the Study:
- To evaluate the efficacy of local bone graft in achieving fusion in PLF.
- To compare fusion rates between PLF and PLF with interbody fusion using only local bone graft.
- To assess the fusion rates in a prospective, multicenter, randomized controlled trial.
Main Methods:
- A prospective, multicenter, randomized controlled trial involving 241 patients undergoing single-level lumbar fusion.
- Patients received either PLF or PLF with interbody fusion, exclusively using local bone graft.
- Fusion assessment was performed using radiographs and computed tomography (CT) at 6 and 12 months.
Main Results:
- For PLF, bilateral fusion rates were 18% at 6 months and 35.7% at 12 months; unilateral rates were 28.8% at 6 months and 50.3% at 12 months.
- For PLF with interbody fusion, bilateral fusion was 1.1% at 6 months and 5.4% at 12 months (all three areas); unilateral fusion was 11.7% at 6 months and 50.8% at 12 months (at least one area).
- Local bone graft demonstrated substantially lower fusion rates compared to the established benchmark of ICBG.
Conclusions:
- Local bone graft, when used alone in PLF or PLF with interbody fusion, resulted in significantly lower fusion rates.
- The fusion rates achieved with local bone graft did not meet the benchmark established by autologous iliac crest bone graft.
- Further research may be needed to optimize local bone graft utilization or explore alternative grafting strategies in lumbar fusion.
