Progress, Challenges And Opportunities In Disc Space Preparation For Lumbar Interbody Fusion

Lumbar interbody fusion from a posterior approach affords the advantage of adding interbody fusion to a posterolateral fusion while avoiding the added morbidity of an anterior approach to the spine. Transforaminal lumbar interbody fusion (TLIF) provides anterior column support through a single posterolateral approach to the disc space with minimal neural retraction and disruption of only one facet joint. While the cross-sectional area of bone required to obtain an adequate arthrodesis remains unclear, case series consistently report high fusion rates for TLIF. However, prior studies have demonstrated difficulty in removing sufficient disc material through a unilateral approach. It is believed that a larger area of bony contact between the grafts and the vertebral bodies heightens the chances of successful interbody fusion. However, specific regions of the disc space, such as the contralateral posterior quadrant, remain difficult to access with conventional instruments and techniques. This work was supported by research grants from Endius, Inc. and HydroCision, Inc. The views expressed in this article are those of the author(s) and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.