PLF - posterolateral Inter transverse Fusion

Indication-

• Spondylolisthesis (isthmus, degenerative, or postlaminectomy spondylolisthesis)
• Degenerative disc disease ,Multilevel Prolapse Intervertebral Disc (PID), Complex Spinal Stenosis
• Mechanical instability due to Spinal Trauma/ Spinal Tumor / Spinal Metastasis
• Unstable spine due to spinal infection eg Tuberculosis
• Unstable spine due to Spinal Deformity- Scoliosis or Kyphosis

Advantages

• Simpler, quicker
• Can be performed in cases with multiple prior surgeries

Disadvantages

• No anterior column support
• Fusion mass away from IAR (instantaneous axis of rotation)

Procedure-

In a posterolateral gutter fusion, the surgical approach to the spine is from the back through a midline incision that is approximately three inches to six inches long.

• First,bone graft is obtained from the pelvis (the iliac crest or spinous proces is used as autograft Most spine surgeons work through the same incision to obtain the bone graft and to perform the spinal fusion.
• Pedicular screw placement
• Decompression by removing spinous proces and bilateral lamina
• Next, the harvested bone graft is laid out in the posterolateral portion of the spine. This region lies on the outside of the spine and is a very vascular area, which is important because the fusion needs blood to supply the nutrients for it to grow.

Risk factor

Determining whether or not a fusion grows in solidly, including

• Smoking cessation. It is generally advisable to quit smoking prior to a spinal fusion surgery, as nicotine is a direct toxin to bone graft and will prevent the bone from forming.
• Limited motion. Bone forms better if motion is limited, so patients are advised to avoid bending, lifting, and twisting for three months after spinal fusion surgery.