Uninstrumented posterolateral fusion as an adjunct to interbody fusion

Many surgeons believe that the use of posterior instrumentation with interbody fusion, cages increases the stability of the construct and improves the overall outcome of the procedure, especially when a posterior procedure is performed. This retrospective review included patients who underwent posterior lumbar interbody fusion (PLIF) with BAK cages (Zimmer Spine, Minneapolis, MN) and uninstrumented posterolateral fusion in 1 or more levels of the lumbar,spine. Demographic and surgical data were collected from the patients' charts. Pain scores were noted at pre- and postoperative time points. Patient functioning was ranked after surgery. Radiographs were independently assessed. These 72 patients had a mean duration of back pain of 51 months and a mean duration of leg pain of 38.2 months. The predominant indication was degenerative disk disease with back and leg pain. Most of these patients underwent previous lumbar surgery (55.5%), and almost half of these patients (45%) had previous lumbar implants or instrumentation. Mean estimated blood loss and mean hospital stay were 1,384 mL and 4.7 days, respectively. Back and leg pain scores decreased significantly after surgery. The mean postoperative function score was 3.7, indicating a mildly limited activity level. There were no significant differences in pain or function between single- and multilevel procedures. Fusion assessment revealed a 94.3% fusion rate. It is apparent that even in this difficult population in which a large number of patients have undergone previous lumbar surgery, PLIF with a posterolateral fusion procedure can lead to positive outcomes. Uninstrumented posterolateral fusion can be used successfully to supplement interbody fusion and provide adequate pain relief to patients.