Instrumented Plif In Lumbar Degenerative Spine: Principles, Indications, Technical Aspects, Results, Complications And Pitfalls

Abstract

The main challenge in the surgical treatment of lumbar degenerative spinal stenosis is to achieve adequate decompression of the neural structures without inducing iatrogenic instability, keeping or restoring a good lordosis and correcting or preventing spinal deformity Sometimes nerve root decompression could be achieved only by restoration of the height of the intervertebral space and by a large opening of the lateral recesses and the foramen. Large bone resection may be indeed required. Decompression surgery for spinal stenosis due to degenerative changes producing claudication is successful in most patients. According to the literature, the rate of further spinal instability is from 5 to 10 % and the risk of postoperative additional forward slip in degenerative spondylolisthesis is assessed between 10 and 18 % of the patients treated without fusion. Even if further horizontal dislocation did not lead to worse clinical results, it is logical for the surgical treatment not only to aim the most efficient decompression of the neurological structures by using adequate bone resection and restoration of the intervertebral height by the distractive interbody fusion, but also the second aim for surgery is to prevent postoperative destabilisation by using the same intervertebral fusion.