Posterolateral lumbar fusion

Posterolateral lumbar fusion is an alternative technique to lumbar interbody fusion and can be a primary procedure or performed after lumbar laminectomy for spinal decompression to aid in stability after disruption of the posterior tension band. Posterior instrumentation via pedicle screws and rod fixation may also be performed.

Indications

• fracture
• spondylolisthesis
• tumors
• spinal instability ²

Procedure

• median or paraspinal approach with exposure and decortication of the vertebral arch from the superior articular process to the transverse process
• bone graft (e.g. bone block, bone strips, bone chips) obtained from the sacral ala or ilium or use of an artificial hydroxyapatite block
• bone graft material is placed between the transverse processes of the levels to be fused ^4,6

Complications

• non-union may result in spinal instability, loss of spinal alignment ⁵
• adjacent segment degeneration ⁵

Outcomes

• bone union occurs in ~90% of patients (range 83-95%) ⁴