Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 11: interbody techniques for lumbar fusion

Standards. There is insufficient evidence to recommend a treatment standard. Guidelines. In the context of a single-level stand-alone ALIF or ALIF with posterior instrumentation, the addition of a PLF is not recommended as it increases operating room time and blood loss without influencing the likelihood of fusion or the functional outcome. Options. 1) It is recommended that both PLF and interbody fusion (PLIF, TLIF, or ALIF) techniques be considered as treatment options for patients with low-back pain due to DDD at one or two levels. 2) Placement of an interbody graft is recommended as a treatment option to improve fusion rates and functional outcome in patients undergoing surgery for low-back pain due to DDD at one or two levels. The surgeon is cautioned that the marginal improvement in fusion rates and functional outcome with these techniques is associated with increased complication rates, particularly when combined approaches (that is, 360°) are used. 3) The use of multiple approaches (anterior and posterior) to accomplish lumbar fusion is not recommended as a routine option for the treatment of patients with low-back pain without deformity.