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Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches.

Cole CD, McCall TD, Schmidt MH, Dailey AT - Curr Rev Musculoskelet Med (2009)

Bottom Line: A review of the literature is performed wherein the history, indications for surgery, surgical procedures with their respective biomechanical advantages, potential complications, and grafting substances are presented.Along with the technical advancements and improvements in grafting substances, the indications and use of PLIF and TLIF have increased.The chief advantages of the TLIF procedure compared with the PLIF procedure included a decrease in potential neurological injury, improvement in lordotic alignment given graft placement within the anterior column, and preservation of posterior column integrity through minimizing lamina, facet, and pars dissection.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University of Utah Medical Center, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.

ABSTRACT
The authors review and compare posterior lumbar interbody fusion (PLIF) with transforaminal lumbar interbody fusion (TLIF). A review of the literature is performed wherein the history, indications for surgery, surgical procedures with their respective biomechanical advantages, potential complications, and grafting substances are presented. Along with the technical advancements and improvements in grafting substances, the indications and use of PLIF and TLIF have increased. The rate of arthrodesis has been shown to increase given placement of bone graft along the weight-bearing axis. The fusion rate across the disc space is further enhanced with the placement of posterior pedicle screw-rod constructs and the application of an osteoinductive material. The chief advantages of the TLIF procedure compared with the PLIF procedure included a decrease in potential neurological injury, improvement in lordotic alignment given graft placement within the anterior column, and preservation of posterior column integrity through minimizing lamina, facet, and pars dissection.

No MeSH data available.


Related in: MedlinePlus

Schematic representation of lumbar spine demonstrating the angle of interbody graft insertion for the PLIF procedure (top, medial) and TLIF procedure (bottom, lateral)
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Related In: Results  -  Collection


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Fig2: Schematic representation of lumbar spine demonstrating the angle of interbody graft insertion for the PLIF procedure (top, medial) and TLIF procedure (bottom, lateral)

Mentions: Patients are placed prone on a surgical frame (i.e., Jackson table) to accentuate a lordotic position of the lumbar spine. After the levels of interest are exposed, the posterior spinal elements are removed to expose the traversing nerve roots and lateral extent of the disc space (Figs. 1, 2). The dorsal third of the interspinous ligament may be preserved to act as a fulcrum for a dural retractor and to preserve a tension band posteriorly. The thecal sac and traversing nerve roots are mobilized and retracted to the midline, with care taken to protect the dural and neural contents with a retractor. After exposure of the posterior annulus, a complete discectomy is performed using rongeurs, disc shavers, and downbiting curved curettes. Only by completely removing the disc and denuding the cartilaginous endplates can an environment conducive to fusion be provided. In addition, disc height may be restored through the use of distractors with serially increasing heights. By increasing the disc height, tension is placed on the annulus fibrosis, and the bone graft is placed under a compressive load, which will help the fusion process.Fig. 1


Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches.

Cole CD, McCall TD, Schmidt MH, Dailey AT - Curr Rev Musculoskelet Med (2009)

Schematic representation of lumbar spine demonstrating the angle of interbody graft insertion for the PLIF procedure (top, medial) and TLIF procedure (bottom, lateral)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2697340&req=5

Fig2: Schematic representation of lumbar spine demonstrating the angle of interbody graft insertion for the PLIF procedure (top, medial) and TLIF procedure (bottom, lateral)
Mentions: Patients are placed prone on a surgical frame (i.e., Jackson table) to accentuate a lordotic position of the lumbar spine. After the levels of interest are exposed, the posterior spinal elements are removed to expose the traversing nerve roots and lateral extent of the disc space (Figs. 1, 2). The dorsal third of the interspinous ligament may be preserved to act as a fulcrum for a dural retractor and to preserve a tension band posteriorly. The thecal sac and traversing nerve roots are mobilized and retracted to the midline, with care taken to protect the dural and neural contents with a retractor. After exposure of the posterior annulus, a complete discectomy is performed using rongeurs, disc shavers, and downbiting curved curettes. Only by completely removing the disc and denuding the cartilaginous endplates can an environment conducive to fusion be provided. In addition, disc height may be restored through the use of distractors with serially increasing heights. By increasing the disc height, tension is placed on the annulus fibrosis, and the bone graft is placed under a compressive load, which will help the fusion process.Fig. 1

Bottom Line: A review of the literature is performed wherein the history, indications for surgery, surgical procedures with their respective biomechanical advantages, potential complications, and grafting substances are presented.Along with the technical advancements and improvements in grafting substances, the indications and use of PLIF and TLIF have increased.The chief advantages of the TLIF procedure compared with the PLIF procedure included a decrease in potential neurological injury, improvement in lordotic alignment given graft placement within the anterior column, and preservation of posterior column integrity through minimizing lamina, facet, and pars dissection.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University of Utah Medical Center, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.

ABSTRACT
The authors review and compare posterior lumbar interbody fusion (PLIF) with transforaminal lumbar interbody fusion (TLIF). A review of the literature is performed wherein the history, indications for surgery, surgical procedures with their respective biomechanical advantages, potential complications, and grafting substances are presented. Along with the technical advancements and improvements in grafting substances, the indications and use of PLIF and TLIF have increased. The rate of arthrodesis has been shown to increase given placement of bone graft along the weight-bearing axis. The fusion rate across the disc space is further enhanced with the placement of posterior pedicle screw-rod constructs and the application of an osteoinductive material. The chief advantages of the TLIF procedure compared with the PLIF procedure included a decrease in potential neurological injury, improvement in lordotic alignment given graft placement within the anterior column, and preservation of posterior column integrity through minimizing lamina, facet, and pars dissection.

No MeSH data available.


Related in: MedlinePlus