Posterior lumbar interbody fusion with restoration of lamina and facet fusion.
METHODS
To report the techniques and surgical results of posterior lumbar interbody fusion with restoration of the lamina and facet fusion.


OBJECTIVE
To present a technique to reconstruct the posterior construct in posterior lumbar interbody fusion.


BACKGROUND
Successful arthrodesis in posterior lumbar interbody fusion requires both a large amount of graft and maximal graft filling, it also requires an excessive distraction of neural structures and excessive removal of the facet-lamina structure, which plays a significant mechanical role, especially in rotatory stability.


METHODS
This study consisted of 36 surgery patients comprising 27 cases of chronic herniated lumbar disc, 4 caused by failed back surgery syndrome, 3 by recurrent lumbar disc herniation, and 2 by apophysis fracture with disc avulsion. The facetolaminotomy was performed by osteotomizing bilateral pars interarticularis with a Gigli saw. Posterior lumbar interbody fusion was performed through the more widely exposed intervertebral space by inserting a pair of carbon fiber cages and medial iliac bone blocks between the cages. The facetolaminotomy flap was returned to the previous site and fixed by translaminar and transisthmic screw fixation. Bilateral facet arthrodesis was also performed.


RESULTS
There were no neural complications related to facetolaminotomy by using the Gigli saw, nor were there any complications related to the screw fixation for the restoration of the posterior construct. Of the 22 patients available for more than a 6-month postoperative follow-up period, radiologic union at the interbody fusion site and at both pars interarticularis was noted in 18. An incomplete union at unilateral pars interarticularis was noted in the other 4 patients.


CONCLUSIONS
The technique of posterior lumbar interbody fusion with restoration of the lamina and facet fusion not only provides a wide interspace for safe and effective posterior lumbar interbody fusion but also restores the posterior constructs, thereby preserving its important mechanical roles and often even achieving natural circumferential arthrodesis.
Jun
B Y
BY
Department of Neurosurgery, College of Medicine, Inha University, Inchun, Korea. byjun@dragon.inha.ac.kr
D001863:Bone Screws; D002908:Chronic Disease; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008159:Lumbar Vertebrae; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D012008:Recurrence; D013123:Spinal Fusion / Q000379:methods*; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome