Divergent bilateral PLIF with cortical screw fixation: Description of latest trajectory for interbody approach from midline publicity.
World Neurosurg. 2018 Feb 17;:
Authors: Bohl MA, Hlubek RJ, Kakarla UK, Chang SW
BACKGROUND: A serious disadvantage to using cortical bone trajectory pedicle screws (CBTPS) with conventional posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) grafts is that conventional graft insertion trajectories require a wider posterior publicity. This wider publicity, past the boundaries in any other case required for CBTPS placement, negates a main good thing about CBTPS fixation.
OBJECTIVE: To outline another surgical approach for interbody graft placement that, when used together with CBTPS fixation, permits each minimal tender tissue dissection and optimum graft placement.
METHODS: A staff of neurosurgeons specializing within the therapy of spinal pathologies developed a surgical approach for insertion of bilateral PLIF grafts that enhances the rules of CBTPS fixation. This system is illustrated in a affected person present process lumbosacral decompression, CBTPS fixation, and Three-column arthrodesis.
RESULTS: The described approach makes use of a divergent trajectory of bilateral PLIF grafts fairly than the standard parallel or convergent trajectories.
CONCLUSION: A divergent trajectory affords quite a few advantages: first, by aiming medially to laterally with the interbody graft, one recapitulates many benefits of CBTPS, together with avoidance of large tissue dissection, better intergraft quantity out there for bone grafting, and better graft protection of the hypophyseal ring. The possible assortment of consequence knowledge for sufferers who bear lumbosacral fusion utilizing the divergent PLIF approach is ongoing.
PMID: 29462734 [PubMed – as supplied by publisher]