Anthony A Salerni1. 1. Lakes Region General Hospital, Laconia, New Hampshire, USA. asalerni@orthopa.com
Abstract
OBJECT: Despite the technical innovations that posterior approaches for lumbar fusion have undergone, the goal of a significant reduction in the extent of dissection has remained elusive. Because extensive muscular dissection is related to both acute and chronic pain, a reproducible minimally invasive posterior approach to lumbar interbody fusion would have significant clinical value. The technical aspects of a minimally invasive approach to posterior lumbar interbody fusion (microPLIF) with fixation involving tools developed for videoscopic discectomy will be described. METHODS: The technical description of this microPLIF procedure is based on experience gained in the first 38 cases. Outcomes categorized using a modified Macnab criteria are reported for 13 patients in whom 1 year or more of follow-up data were available. All procedures were completed. The section of anulus fibrosus that was exposed provided access for a thorough discectomy and endplate preparation. Outcome in 11 of the 13 patients in whom outcome data were available was excellent or good. Six of these patients returned to work between 3 and 12 weeks postoperatively. Two patients suffered complications related to insertion of the interbody device. CONCLUSIONS: This procedure involves a reproducible technique that results in a construct that is radiographically identical to that which could be expected from any standard open procedure. The minimized muscular dissection results in a tremendous improvement in postoperative mobility. All complications in this series were related to the placement of femoral cortical allograft implants. The use of a modified cement restrictor should eliminate the risk of interbody device placement.
OBJECT: Despite the technical innovations that posterior approaches for lumbar fusion have undergone, the goal of a significant reduction in the extent of dissection has remained elusive. Because extensive muscular dissection is related to both acute and chronic pain, a reproducible minimally invasive posterior approach to lumbar interbody fusion would have significant clinical value. The technical aspects of a minimally invasive approach to posterior lumbar interbody fusion (microPLIF) with fixation involving tools developed for videoscopic discectomy will be described. METHODS: The technical description of this microPLIF procedure is based on experience gained in the first 38 cases. Outcomes categorized using a modified Macnab criteria are reported for 13 patients in whom 1 year or more of follow-up data were available. All procedures were completed. The section of anulus fibrosus that was exposed provided access for a thorough discectomy and endplate preparation. Outcome in 11 of the 13 patients in whom outcome data were available was excellent or good. Six of these patients returned to work between 3 and 12 weeks postoperatively. Two patients suffered complications related to insertion of the interbody device. CONCLUSIONS: This procedure involves a reproducible technique that results in a construct that is radiographically identical to that which could be expected from any standard open procedure. The minimized muscular dissection results in a tremendous improvement in postoperative mobility. All complications in this series were related to the placement of femoral cortical allograft implants. The use of a modified cement restrictor should eliminate the risk of interbody device placement.