Surgical techniques: Posterior lumbar interbody fusion

The posterior lumbar interbody fusion (PLIF) was first described by Cloward in 1953. As the procedure has gained more popularity over the past several decades, studies reporting fusion rates have been high. The introduction of pedicle screw instrumentation and concomitant posterolateral fusion with bone grafting makes the likelihood of successful fusion of combined PLIF and posterolateral instrumentation extremely high. The PLIF is performed from a true direct posterior angle, retracting the dura and preserving part of the facet joint. There is a significant risk of complications with the PLIF procedure and careful surgical technique should be adhered to in order to minimize these risks. The transforaminal interbody fusion (TLIF) was introduced by Harms as an adaptation of the PLIF, has similar indications, and is designed primarily to decrease the amount of dural retraction necessary during the discectomy and interbody cage insertion. This chapter will discuss the indications for PLIF, including deciding between the PLIF and other interbody fusion techniques, the surgical technique, and complications of the procedure and their management.