Unilateral posterior lumbar interbody fusion: simplified dowel technique

Two hundred sixteen patients were treated by a simplified unilateral posterior lumbar interbody fusion (U-PLIF) in which the disc was removed and replaced by bone. The disc was approached far laterally by removing two-thirds of the superior facet preserving most of the ligamentum flavum, removing the disc, decorticating in a semicircular fashion the adjacent vertebral bodies unilaterally close to the midline, and packing the anterior one-fourth of the interspace with cancellous bone chips. The bone chips were covered with up to five half-thickness bone dowels. Consolidation of the fusion and stabilization of the motion segment of Junghanns from either the cephalad or caudal end of the bone grafts were verified by motion roentgenographic films, CT scans, and/or examinations during the follow-up period, which ranged from 16 years to a minimum of one year. Of the 34 cases selected for CT scan, 25 had lateral reconstruction performed, and solid unilateral fusion was confirmed in 21 cases (84%). The advantages of the unilateral approach include an intact ligamentum flavum overlying nerve roots.