Posterior Fusion Alternatives for Low Back Pain

The diagnosis and treatment of low back pain continue to be challenging despite a multitude of advances in imaging and surgical technologies. For those patients with debilitating low back pain that fail conservative treatment, lumbar fusion should be considered. Retrospective and prospective studies support the use of lumbar fusion in treatment of debilitating low back pain. While the time-honored posterior approach is the posterolateral fusion, interbody techniques of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion have become increasingly popular since they typically result in a more rigid construct and a higher fusion rate. Since there is no conclusive evidence that these techniques result in improved clinical outcomes, the benefits of achieving the higher fusion rates must be balanced with the increased risks and added operative time engendered.

Keywords: posterolateral lumbar fusion, PLIF, TLIF, lumbar DDD, chronic low back pain