Stabilization and arthrodesis of the lumbar spine may be achieved through a variety of surgical approaches. Traditionally, direct anterior or posterior surgical approaches have been employed that take advantage of natural tissue planes and midline orientation. However, today’s surgeons have…
Overview Anterior approaches to the lumbar spine have been utilized to treat lumbar degenerative disc disease for over a century. The approach evolved from a transperitoneal approach to using a retroperitoneal surgical corridor. , The retroperitoneal approach became a favored…
Introduction Traditional transforaminal lumbar interbody fusion (TLIF) is performed through a large midline open incision on the back. With this approach the surgeon must dissect and retract the paraspinal musculature in order to access the target level This can lead…
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…