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Posterior Lumbar Interbody Fusion
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 cages. The application of pedicle screws to augment arthrodesis , and minimally invasive spine (MIS) percutaneous techniques have refined the PLIF procedure. In recent years, expandable interbody implants, real-time 3D navigation/image guidance, and spinal robotics continue to transform the PLIF procedure.
The indications for performing a PLIF include recurrent disc herniation, failed back surgery syndrome, spondylolisthesis, bilateral midline disc herniation, segmental instability, and degenerative disc disease. Compared with classic posterolateral arthrodesis techniques, PLIF offers improved blood supply to the fusion/graft construct, even load sharing on the graft, decompression of the neural foramina and nerve roots, a wide area of graft-intervertebral body contact, and restoration of the interbody distance and neural foraminal height while maintaining segmental lordosis at the fused level.
Patient Selection
As with any operation, patient selection is a critical factor in lumbar spine surgery where pre-existing pain syndromes and dependence on medication may complicate the pre- and postoperative care of patients. The rationale for performing a PLIF is that fusion of the vertebral segments eliminates any instability that may be causing recurrent or persistent pain. Unless a focal neurologic deficit is identified, aggressive nonoperative therapy should be tried prior to committing the patient to an operation.
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