Anterior lumbar interbody fusion: indications for its use and notes on surgical technique.

A technique using dowel cutting instruments for anterior lumbar interbody fusion operations is recommended for the treatment of other failed spinal operations; certain disc lesions; in the management of selected cases of spondylolisthesis; certain spinal infections; following some vertebral fractures; correction of selected spinal deformities and in the treatment of rare miscellaneous cases, e.g., vertebral body tumors and nucleus pulposus calcification. Extra peritoneal approaches to the lumbar vertebral column are recommended. Dowel cavities are cut to predetermined depths with specially designed cutters of appropriate size. The greater bulk of disc tissues and vertebral end plate cartilages are then removed using ring curettes and pituitary rongeurs. Autogenous grafts are cut from the iliac crest using a cutter one size larger than that used to prepare the intervertebral dowel cavities. With the depths of the dowel cavities having been checked with a depth gauge, the grafts are duly impacted after careful retraction of all adjacent structures away from the cavities.