Application And Discussion Of Lumbar Fusion Techniques In Lumbar Degenerative Diseases

Degenerative disease of the lumbar spine is common in spine surgery,which is one of the most frequent causes of disability in the ageing population.It develops symptoms of low back pain,radiculalgia or claudication result in mobility reduced and poor quality of life.Surgical fusion of degenerative levels is an effective treatment option to stabilize the painful motion segment and may provide decompression of the neural elements,restore lordosis and correct deformity.The surgical options for lumbar fusion include: posterolateral fusion(PLF),anterior lumbar interbody fusion(ALIF),posterior lumbar interbody fusion(PLIF),transforaminal lumbar interbody fusion(TLIF),minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF),lateral lumbar interbody fusion(LLIF)and oblique lumbar interbody fusion(OLIF).Indications of lumbar fusion may include: degenerative lumbar disease,such as discogenic low back pain,lumbar stenosis,lumbar spondylolisthesis and spinal deformity.In general,traditional PLF is simple and useful;however overabundance soft tissues are always stripped,and overall fusion rates are not high yet.PLIF is frequently used with acceptable fusion rates and low complication rates;however it is limited by dural sacs and nerve root retraction,along with iatrogenic injury to the paraspinal musculature.TLIF was remoulded from PLIF,which reduced damage of the posterior rachial structure;however opposite side decompression is difficult and curative effect is not stable.ALIF avoids injury to the posterior lumbar structure,but is prone to severe approach-related abdominal and vascular complications.In order to overcome a series of integration-related problems of traditional lumbar surgery,minimally invasive approaches have been rapid development.MIS-TLIF can reduce surgery-related complications.In addition,lateral andOLIF techniques have potential risks to the lumbar plexus and psoas muscle,and clinical efficacy and fusion rate require validation in long-term follow-up.This article aims to comprehensively review the available literature and evidence of various lumbar fusion technologies,and then provide indications and contraindications as well as benefits and disadvantages for each method.Finally propose a set of recommendations and guidelines for the lumbar fusion surgery options.