Instrumentation of the lumbar spine. An overview

The use of any implant system to promote arthrodesis of any segment of the spine is only as good as the technique of surgical arthrodesis. The success of the implant depends, in short, on the success of the arthrodesis. A successful arthrodesis depends on meticulous soft-tissue debridement, decortication, and copious iliac bone grafting or allograft bone grafting if autogenous graft is deficient. If the anterior approach is used, complete and thorough debridement of the intervertebral disc and cartilaginous end-plates with meticulous bone grafting of the interspace is essential for a successful fusion. A pseudarthrosis in the presence of an implant will eventually lead to implant failure. In implants placed anteriorly, this may lead to severe consequences and complications. If implants are used anteriorly and anterior arthrodesis is not achieved, a posterior spinal fusion should be carried out. All implants used anteriorly should be placed laterally away from great vessels, particularly the femoral artery. If separation from the vessels and the implant is not possible, the implant should either be removed or the vessels should be protected with a Dacron graft placed over any protuberant metal.