title: Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 11: interbody techniques for lumbar fusion.
abstract: Interbody fusion techniques have been promoted as an adjunct to lumbar fusion procedures in an effort to enhance fusion rates and potentially improve clinical outcome. The medical evidence continues to suggest that interbody techniques are associated with higher fusion rates compared with posterolateral lumbar fusion (PLF) in patients with degenerative spondylolisthesis who demonstrate preoperative instability. There is no conclusive evidence demonstrating improved clinical or radiographic outcomes based on the different interbody fusion techniques. The addition of a PLF when posterior or anterior interbody lumbar fusion is performed remains an option, although due to increased cost and complications, it is not recommended. No substantial clinical benefit has been demonstrated when a PLF is included with an interbody fusion. For lumbar degenerative disc disease without instability, there is moderate evidence that the standalone anterior lumbar interbody fusion (ALIF) has better clinical outcomes than the ALIF plus instrumented, open PLF. With regard to type of interbody spacer used, frozen allograft is associated with lower pseudarthrosis rates compared with freeze-dried allograft; however, this was not associated with a difference in clinical outcome.
authors: Department of Neurological Surgery, University of California, San Francisco, California;
authors: Praveen V
authors: PV
authors: Mummaneni
authors: Sanjay S
authors: SS
authors: Dhall
authors: Jason C
authors: JC
authors: Eck
authors: Michael W
authors: MW
authors: Groff
authors: Zoher
authors: Z
authors: Ghogawala
authors: William C
authors: WC
authors: Watters
authors: Andrew T
authors: AT
authors: Dailey
authors: Daniel K
authors: DK
authors: Resnick
authors: Tanvir F
authors: TF
authors: Choudhri
authors: Alok
authors: A
authors: Sharan
authors: Jeffrey C
authors: JC
authors: Wang
authors: Michael G
authors: MG
authors: Kaiser
mesh_terms: D016025:Bone Transplantation / Q000592:standards; D019317:Evidence-Based Medicine; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000473:pathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D013122:Spinal Diseases / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000592:standards*; D013168:Spondylolisthesis / Q000473:pathology / Q000601:surgery
keywords: ALIF = anterior lumbar interbody fusion; DDD = degenerative disc disease; FRA = femoral ring allograft; LOS = length of stay; ODI = Oswestry Disability Index; PLF = posterolateral lumbar fusion; PLIF = posterior lumbar interbody fusion; PPS = instrumented PLF with pedicle screws; SF-36 = 36-Item Short Form Health Survey; TLIF = transforaminal lumbar interbody fusion; VAS = visual analog scale; bone graft; fusion; lumbar spine; practice guidelines; spondylosis