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.
1Department of Neurosurgery, Prince of Wales Private Hospital, Australia
2Neuro Spine Clinic, Randwick, New South Wales, Australia
3University of New South Wales, Kensington, New South Wales, Australia
To illustrate a hybrid technique that involves a combination of open decompression and Posterior Lumbar Interbody Fusion (PLIF) and percutaneously placed pedicle screws. This technique allows for PLIF via a midline incision and approach, and decompression without compromise in operative time and visualisation. Furthermore, this approach is proposed to reduce post-operative wound pain by: smaller midline incision, significantly reduced muscle trauma by not dissecting the paraspinal muscles off the facet joint complex, avoidance of a posterolateral fusion to facilitate limited lateral muscle dissection off the transverse processes.
PLIF fusion rates are comparable to posterolateral fusion rates, as well as providing greater sagittal and coronal balance. There is positive evidence that degenerative spondylolisthesis with canal and/or foraminal stenosis requires stabilisation when decompressed via laminectomy.
Patients with Grade I-II spondylolisthesis at L4/5 with moderate – severe canal/foraminal stenosis undergo a midline PLIF at L4/5, with closure of the midline incision. Percutaneous pedicle screws are inserted, therefore minimising local muscle trauma, with reduction of the spondylolisthesis performed using the pedicle screw construct. Rods are inserted percutaneously to link the L4 and L5 pedicle screws. Image intensification is used to confirmed satisfactory screw placement and reduction of the spondylolisthesis.
Percutaneous lumbar pedicle screws can be combined with a standard midline PLIF to reduce postoperative wound pain while allowing for satisfactory screw placement.
Percutaneous lumbar pedicle screws; Posterior lumbar interbody fusion; Spondylolisthesis; 80/20 technique; 50/50 technique
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