Lateral-PLIF for Lumbar Spinal Arthrodesis: A Detailed Step-By-Step Surgical Technique

Posterior lumbar interbody fusion (PLIF) is widely recognized as an effective surgical approach for treating degenerative lumbar spine conditions. To address challenges associated with the classical PLIF technique, such as the need for extensive neural retraction and the associated risk of dural tears, we developed a novel variant, the Lateral-PLIF, which optimizes cage placement to enhance outcomes and minimize risks. This article offers a detailed, step-by-step explanation of the procedure, highlighting its advantages in the operative field. Here we present a case of a posterior interbody fusion performed for a lumbar degenerative disease. The technique involves bilateral cage placement through the transition zone, between the central canal and intervertebral foramen, just above the lateral recess. This entry point is strategically chosen as it is safer for respecting the surrounding nervous structures, avoiding manipulation of the foraminal root, while reducing medial dural retraction and providing a better cage orientation. Finally, the technique keeps the advantages of the bilateral approach: direct bilateral decompression, high-quality discectomy, and endplates cleaning performed from each side, progressive distraction achieved from the disc space alternating right/left, and opportunity for massive bone grafting. Lateral-PLIF is a safe and effective surgical technique for lumbar interbody fusion. Its high fusion rate, improved functional outcomes, and low complication rates make it a promising alternative to traditional PLIF. This step-by-step article serves as a practical guide for surgeons, promoting the broader adoption and further validation of this technique in comparative studies.