Posterior lumbar interbody fusion technique: complications and pitfalls

To assure a high degree of lumbar interbody fusion, four biomechanic principles should be observed: preservation of posterior portion of the motion segment (this would stabilize and compress the grafts); near total discectomy to render a larger area for recipient graft site; maximum impaction of mixed cancellous and unicortical peg grafts; and partial decortication to avoid invasion into the soft vascular cancellous bone in a deeper area. The result of 465 cases of PLIF over a ten-year period showed 82% clinical satisfactory results and a 88% satisfactory fusion rate. Various complications and pitfalls related to this procedure suggest that with meticulous technique and close adherence to the established protocol, PLIF can be performed safely with a high success rate of fusion.