Table 1. Overview of interbody fusion techniques and their advantages and disadvantages (13,16,31,37,40-60).
| Interbody fusion technique | Indications | Advantages | Disadvantages |
|---|---|---|---|
| PLIF | Degenerative pathologies including segmental instability, recurrent disc herniation, symptomatic spinal stenosis, pseudarthrosis and deformity | Most common, well trained surgeons | Paraspinal muscle damage and hence prolonged postoperative recovery |
| Good posterior visualization and possibility for decompression | Aggravated endplate preparation | ||
| Good interbody height restoration | Challenging correction of coronal imbalance and restoration of lumbar lordosis | ||
| Option for 360° fusion through single approach | Neural/dural injury | ||
| TLIF | Degenerative pathologies including segmental instability, recurrent disc herniation, symptomatic spinal stenosis, pseudarthrosis and deformity | Sparing posterior ligamentous and reducing iatrogenic paraspinal muscle damage and improved postoperative biomechanical stability | Difficult endplate preparation |
| Reducing the risk of nerve root and dural injury | Limited overall view comparison to conventional bilateral PLIF | ||
| Option for 360° fusion through single approach | Challenging correction of coronal imbalance and restoration of lumbar lordosis | ||
| LLIF | Degenerative pathologies including deformities in combination with a posterolateral fusion, lumbar laterolisthesis | Minimal invasive muscle-splitting approach with potential for faster postoperative mobilization | Not suitable for L5/S1 fusion due to iliac crest bone, severe central canal stenosis, bony lateral recess stenosis and high-grade spondylolisthesis/instability |
| Sufficient deformity correction | Only for patients without prior retroperitoneal surgery or adverse vascular anatomy | ||
| Endplate preparation | Injury of lumbar plexus and iliac vessels at caudal levels with difficulties to control due to approach | ||
| Cage size diameter larger in comparison to posterior approaches with good correction of lordosis and height restoration | Neuromonitoring is essential due to transpsoas access | ||
| ALIF | Strict anterior suitable for L4/5 and L5/S1 disc pathologies as osteochondrosis | Efficient anterior discectomy similar to LLIF | Visceral and severe vascular injuries |
| Oblique technique access to lumbar spine for degenerative disc disease | Cage size diameter larger in comparison to posterior approaches with good correction of lordosis and height restoration | Retrograde ejaculation | |
| Sparing posterior and anterolateral psoas muscle and neural structures | Increased approach related risks in patients with prior abdominal surgery or adverse vascular anatomy | ||
| In cases of high-grade deformity additional posterolateral fusion |
PLIF, posterior lumbar interbody fusion; TLIF, transforaminal lumbar interbody fusion; LLIF, lateral lumbar interbody fusion; ALIF, anterior lumbar interbody fusion.