Posterior lumbar interbody fusion

The greatest advantage of posterior lumbar interbody fusion (PLIF) is that it dynamically decompresses neural structures by holding the vertebral bodies apart and fusing them into a single motion segment. After ten years of experience with PLIF, the authors recommend a technique that enhances a high rate of fusion by utilizing the following four biomechanical principles: (1) preservation of the integrity of the posterior portion of the motion segment; (2) partial preservation of the integrity of the cortical end-plates; (3) attempted maximal removal of the disc material; and (4) one-piece grafts, as applied to PLIF, a "unigraft" concept, to fill all the disc space compactly with autogenous bone grafts. In a series of 465 cases of PLIF with a follow-up period of at least one year, the authors achieved a fusion rate of 88% and satisfactory clinical results in 82%. The fusion rate and clinical result are further investigated in six different clinical entities: lateral herniated disc, midline disc, degenerative disc, recurrent disc, spinal stenosis, and unstable spine. PLIF, as currently conceived, is an important technique in the surgical management of lumbar disc diseases.