Thoracolumbar Instrumentation and Fusion for Degenerative Disc Disease

  • Sven Kevin TschoekeEmail author


With the increase of an aging population worldwide, patient’s expectations and demands for an improved independent lifestyle have led to innovative strategies in the treatment of degenerative disc disease. Aside from all conservative modalities, new surgical techniques attempt to enable a rapid recovery by reducing iatrogenic injury and complications with shorter operative times. Over the past two decades, the debate over which approach may achieve the highest fusion rates has been opened to a more global view on its efficacy of restoring the overall coronal and sagittal balance of the spine. Thus, the analyses of respective spinopelvic interrelations using modern full body radiographic imaging in an upright standing position have received closer attention and have since been fully included in our therapeutic management and strategical planning. Furthermore, the increasing number of failed primary surgeries and/or adjacent segment degeneration with secondary kyphotic deformity constitute a distinct entity of challenges with rather individual and case-dependent solutions. Today’s advances in spinal instrumentation allow almost any operation to be performed in a minimally-invasive fashion. Regardless of selecting either the retroperitoneal corridor (ALIF, OLIF, LLIF) or traversing the spinal canal with or without osteotomy of the facet joints for segmental mobilsation (PLIF, TLIF, minimally-invasive-surgery (MIS)-TLIF), none of today’s standard techniques have proven to be superior to another. Although each approach has its own risks and benefits, fusion rates or clinical outcomes appear to be similar. However, there is fundamental consensus, that interbody fusion itself is preferable to posterolateral “on-lay” fusion techniques with less postoperative complications and lower rates of pseudarthrosis. In conclusion, the surgeon must always consider all technical options to tailor the treatment to the patient’s individual, but none the less realistic expectations.


  1. 1.
    Teng I, Han J, Phan K, et al. A meta-analysis comparing alif, plif, tlif and llif. J Clin Neurosci. 2017;44:11–7.CrossRefGoogle Scholar
  2. 2.
    Mobbs RJ, Sivabalan P, Li J. Minimally invasive surgery compared to open spinal fusion for the treatment of degenerative lumbar spine pathologies. J Clin Neurosci. 2012;19:829–35.CrossRefGoogle Scholar
  3. 3.
    Mobbs RJ, Phan K, Malham G, et al. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including plif, tlif, mi-tlif, olif/atp, llif and alif. J Spine Surg. 2015;1:2–18.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Eck JC, Hodges S, Humphreys SC. Minimally invasive lumbar spinal fusion. J Am Acad Orthop Surg. 2007;15:321–9.CrossRefGoogle Scholar
  5. 5.
    Benditz A, Madl M, Loher M, et al. Prospective medium-term results of multimodal pain management in patients with lumbar radiculopathy. Sci Rep. 2016;6:28187.CrossRefGoogle Scholar
  6. 6.
    Brunner M, Schwarz T, Zeman F, et al. Efficiency and predictive parameters of outcome of a multimodal pain management concept with spinal injections in patients with low back pain: a retrospective study of 445 patients. Arch Orthop Trauma Surg. 2018;138:901–9.CrossRefGoogle Scholar
  7. 7.
    Liang HF, Liu SH, Chen ZX, et al. Decompression plus fusion versus decompression alone for degenerative lumbar spondylolisthesis: a systematic review and meta-analysis. Eur Spine J. 2017;26:3084–95.CrossRefGoogle Scholar
  8. 8.
    Forsth P, Michaelsson K, Sanden B. Fusion surgery for lumbar spinal stenosis. N Engl J Med. 2016;375:599–600.PubMedGoogle Scholar
  9. 9.
    Barrey C, Jund J, Noseda O, et al. Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J. 2007;16:1459–67.CrossRefGoogle Scholar
  10. 10.
    Blumenthal C, Curran J, Benzel EC, et al. Radiographic predictors of delayed instability following decompression without fusion for degenerative grade I lumbar spondylolisthesis. J Neurosurg Spine. 2013;18:340–6.CrossRefGoogle Scholar
  11. 11.
    Bourghli A, Aunoble S, Reebye O, et al. Correlation of clinical outcome and spinopelvic sagittal alignment after surgical treatment of low-grade isthmic spondylolisthesis. Eur Spine J. 2011;20(Suppl 5):663–8.CrossRefGoogle Scholar
  12. 12.
    Qureshi R, Puvanesarajah V, Jain A, et al. A comparison of anterior and posterior lumbar interbody fusions: complications, readmissions, discharge dispositions, and costs. Spine (Phila Pa 1976). 2017;42:1865–70.CrossRefGoogle Scholar
  13. 13.
    Sheha ED, Meredith DS, Shifflett GD, et al. Postoperative pain following posterior iliac crest bone graft harvesting in spine surgery: a prospective, randomized trial. Spine J. 2018;18(6):986–92.CrossRefGoogle Scholar
  14. 14.
    France JC, Schuster JM, Moran K, et al. Iliac crest bone graft in lumbar fusion: the effectiveness and safety compared with local bone graft, and graft site morbidity comparing a single-incision midline approach with a two-incision traditional approach. Global Spine J. 2015;5:195–206.CrossRefGoogle Scholar
  15. 15.
    Salzmann SN, Shue J, Hughes AP. Lateral lumbar interbody fusion-outcomes and complications. Curr Rev Musculoskelet Med. 2017;10:539–46.CrossRefGoogle Scholar
  16. 16.
    Alanay A, Vyas R, Shamie AN, et al. Safety and efficacy of implant removal for patients with recurrent back pain after a failed degenerative lumbar spine surgery. J Spinal Disord Tech. 2007;20:271–7.CrossRefGoogle Scholar
  17. 17.
    Jeon CH, Lee HD, Lee YS, et al. Is it beneficial to remove the pedicle screw instrument after successful posterior fusion of thoracolumbar burst fractures? Spine (Phila Pa 1976). 2015;40:E627–33.CrossRefGoogle Scholar
  18. 18.
    Stavridis SI, Bucking P, Schaeren S, et al. Implant removal after posterior stabilization of the thoraco-lumbar spine. Arch Orthop Trauma Surg. 2010;130:119–23.CrossRefGoogle Scholar
  19. 19.
    Bridwell KH. Decision making regarding smith-petersen vs. Pedicle subtraction osteotomy vs. Vertebral column resection for spinal deformity. Spine (Phila Pa 1976). 2006;31:S171–8.CrossRefGoogle Scholar
  20. 20.
    Choi HY, Hyun SJ, Kim KJ, et al. Surgical and radiographic outcomes after pedicle subtraction osteotomy according to surgeon’s experience. Spine (Phila Pa 1976). 2017;42:E795–801.CrossRefGoogle Scholar
  21. 21.
    Kim YJ, Bridwell KH, Lenke LG, et al. Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976). 2007;32:2189–97.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Spine SurgeryKlinikum Dortmund gGmbHDortmundGermany

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