title: Hybrid technique for posterior lumbar interbody fusion: a combination of open decompression and percutaneous pedicle screw fixation.
abstract: The authors describe a hybrid technique that involves a combination of open decompression and posterior lumbar interbody fusion (PLIF) and percutaneously inserted pedicle screws. This technique allows performance of PLIF and decompression via a midline incision and approach without compromising operative time and visualization. Furthermore, compared to standard open decompression, this approach reduces post-operative wound pain because the small midline incision significantly reduces muscle trauma by obviating the need to dissect the paraspinal muscles off the facet joint complex and by avoiding posterolateral fusion, thus requiring limited lateral muscle dissection off the transverse processes. A series of patients with Grade I-II spondylolisthesis at L4-5 and moderate-severe canal/foraminal stenosis underwent midline PLIF at L4-5, with closure of the midline incision. Percutaneous pedicle screws were inserted, thereby minimizing local muscle trauma, reduction of the spondylolisthesis being performed by using a pedicle screw construct. Rods were inserted percutaneously to link the L4 and L5 pedicle screws. Image intensification was used to confirmed satisfactory screw placement and reduction of spondylolisthesis. The results of a prospective study comparing a standard open decompression and fusion technique for spondylolisthesis versus the minimally invasive hybrid technique are discussed. The minimally invasive technique resulted in shorter hospital stay, earlier mobilization and reduced postoperative narcotic usage. The long-term clinical outcomes were equivalent in the two groups.
authors: Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia. ralphmobbs@hotmail.com
authors: Ralph J
authors: RJ
authors: Mobbs
authors: Praveenan
authors: P
authors: Sivabalan
authors: Jane
authors: J
authors: Li
authors: Peter
authors: P
authors: Wilson
authors: Prashanth J
authors: PJ
authors: Rao
mesh_terms: D000328:Adult; D000368:Aged; D001863:Bone Screws; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
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