Advances in posterior lumbar interbody fusion.

Since the introduction of the PLIF by Cloward in the 1950s, there have been great improvements in our understanding of the pathophysiology of spinal degenerative diseases and the potential morbidities associated with their surgical management. The advent of durable interbody fusion cages and bone grafting alternatives has lessened the morbidity of bone graft harvesting and disc space collapse and has providing improved stiffness and stability to the affected spinal motion segment. Although criticized by some surgeons for the potential for spinal destabilization and nerve root injuries, newer techniques of posterior interbody access and improved implant designs have led to shortened surgical times, less neurologic injury, and improved overall outcomes. The introduction of the transforaminal lumbar interbody fusion procedure has allowed surgeons to achieve successful fusion without the risk of nerve root tethering that is seen so frequently with standard PLIF techniques. Further study and long-term follow-up regarding its efficacy are necessary before it can be recommended to supplant the more traditional PLIF techniques.