Lumbar fusion is an accepted treatment for spinal deformity, degenerative instability, and iatrogenic instability following decompressive procedures. Lumbar interbody fusion yields certain advantages over posterolateral fusion alone, particularly because of higher rates of fusion. Segmental motion still exists with posterolateral…
The first successful report of a posterior lumbar interbody fusion (PLIF) dates to 1940 when Cloward performed this operation using a shaped spinous process autograft. Since Cloward’s original report, many surgeons have modified this technique using various grafts, implants, and…
Fusion remains the standard method of controlling pain from lumbar spinal instability and is commonly performed in conjunction with decompression procedures. However, unintended consequences of otherwise successful lumbar fusion procedures may occur, including transfer of forces to adjacent segments, possibly…
Introduction The use of pedicle screws for spinal stabilization has become increasingly popular worldwide since their introduction in the 1970s by Roy-Camille, largely replacing spinal hook and laminar wire systems. Pedicle screw systems engage all three columns of the spine…
Introduction Successful fusion is known as arthrodesis; nonunion is referred to as pseudoarthrosis. The goal of arthrodesis is to produce a solid fusion mass connecting one vertebra to another. The first fusion was described in 1911 by two independent surgeons,…
Lumbar Spinal Stenosis The surgical management of lumbar spinal stenosis and degenerative spondylolisthesis is critically shaped by whether a spinal arthrodesis (instrumented or noninstrumented) is performed along with the decompressive procedure. Although the conditions under which these choices are made…
Lumbar spinal arthroplasty was first reported in clinical settings in 1994 by Griffith and colleagues. This early experience was acquired with the first lumbar artificial disc, the Charité I, in patients with degenerative disc disease (DDD). Since that time, a…
Far lateral disc (FLD) herniations account for between 6.5% and 12% of lumbar disc herniations. Operative resection techniques include minimally invasive procedures or microendoscopic alternatives, laminotomy, hemilaminectomy, and laminectomy with or without fusion ( Figs. 147.1 to 147.9 ). The latter…
Introduction The first accurate clinicopathologic descriptions of lumbar disc herniation, by Dandy and Mixter and by Barr, date as far back as 1929 and 1934, respectively. , The technique for open discectomy as practiced today is a modification of the…
Introduction Sciatica and back pain are two of the most common reasons for referral to spine specialists and are a leading cause of physical disability in the United States. Sciatica is characterized by radiating pain in an area of the…