This document summarizes the types and indications for lumbar circumferential fusion surgery. It discusses different techniques for lumbar interbody fusion including ALIF, PLIF, TLIF, and LLIF. PLIF provides decompression through a midline approach while TLIF uses a dorsolateral approach to the facet joint. Circumferential fusion using an interbody technique plus posterior instrumentation is shown to have higher fusion rates and fewer reoperations compared to posterolateral fusion alone. Indications for circumferential fusion include spondylolisthesis, degenerative disc disease, recurrent disc herniation, post-discectomy stenosis, deformity correction, and pseudarthrosis treatment. Both ALIF and T

1. FUSION LUMBAR CIRCUNFERENCIAL.
COMO Y CUANDO HACERLO
DR ZUREN MATUTES FABELO
HOSPITAL SAN JOSE DE HERMOSILLO
CONGRESO CHILENO DE NEUROCIRUGIA.
LA SERENA.8 DE OCTUBRE DEL 2016

2. NO CONFLICTOS DE INTERESES

3. ENFERMEDAD LUMBAR DEGENERATIVA
HERNIA DISCAL LUMBAR
ESTENOSIS LUMBAR
INESTABILIDAD DEGENERATIVA LUMBAR
LUMBAGO DEGENERATIVO

4. HERNIA DISCAL LUMBAR
SINDROME DE COLA DE CABALLO:INDICACION QUIRURGICA DE
EMERGENCIA
DEFICIT MOTOR SIGNIFICATIVO(MENOS 3/5):MENOS DE 72 HORAS
DOLOR RADICULAR REFRACTARIO:MINIMO DE 6-12 SEMANAS DE MANEJO
CONSERVADOR.MUCHOS CASOS NO REQUIEREN CIRUGIA.
METODOS:DISECTOMIA,SECUESTROMIA, ENDOSCOPIA,TECNICAS
INTRADISCALES.

5. ESTENOSIS LUMBAR
NO INDICACION AGUDA
CLAUDICACION NEUROGENICA REFRACTARIA:MINIMO 12 SEMANAS DE
MANEJO CONSERVADOR.MUCHOS CASOS NO REQUIEREN CIRUGIA.MANEJO
QUIRURGICO SUPERIOR AL CONSERVADOR.AUMENTO DE CASOS EN
PRACTICA NEUROQUIRUGICA.
METODOS:LAMINECTOMIA,LAMINOTOMIA, FUSION,ENDOSCOPIA.
VALORAR INESTABILIDAD.

6. INESTABILIDAD LUMBAR DEGENERATIVA
DEFINICION NO CLARA:
+5 MM DE OLISTESIS
+ 3 MM DE MOVIMIENTO EN DINAMICAS
CIFOESCOLIOSIS DEGENERATIVA LUMBAR
+/- ESTENOSIS ESPINAL
+/- ESPONDILOLISTESIS
ENFERMEDAD PROGRESIVA
AUMENTO DE LA INCIDENCIA
AFECTACION DEL BALANCE SAGITAL.

7. Orthop Clin North Am. 2003 Apr;34(2):269-79.
Degenerative scoliosis. Options for surgical management.
Gupta MC1.
Adult degenerative scoliosis patients present a challenge in trying to achieve the
greatest benefit .
Decompression alone is performed in patients with small magnitudes of scoliosis
and minimal lateral listhesis.
Decompression and posterior fusion with instrumentation is performed on
patients with moderate deformity and lateral listhesis, but a balanced sagittal
plane.
The more technically challenging and larger operation, a combined anterior and
posterior fusion with instrumentation, is reserved for those patients with not only
moderate to severe curves, but also coronal and sagittal imbalance.
Performing a smaller operation on these patients may not only be short-lived but
may also start a series of higher-risk revisions.
Degenerative scoliosis patients presents a challenge that is only growing larger in
numbers with the aging population.

8. PARAMETROS ESPINOPELVICOS
IP=PT+SS
PT+SS=VARIABLES

9. LUMBAGO DEGENERATIVO
OSTEOCONDROSIS.CAMBIOS MODICK. RELATIVAMENTE BIEN CORRELACIONADOS
DISCO NEGRO
DISCO COMO GENERADOR DE DOLOR
DISCOGRAFIA???

10. FUSION LUMBAR
-MANEJO EFECTIVO PARA DOLOR LUMBAR
-SE ELIMINA EL DISCO COMO CAUSA DE DOLOR.
-RESTAURA ANATOMIA NORMAL(ALTURA DISCAL,DIAMETRO FORAMINAL,BALANCE SAGITAL)
-LA REALIZACION DE UNA FUSION INTERSOMATICA AUMENTA EL PORCENTAJE DE FUSION
(DISMINUYENDO EL NUMERO DE REOPERACIONES)AUNQUE ESTO NO SE TRASLADA DE FORMA
CONSISTENTE EN UNA MEJORIA CLINICA DE LOS PACIENTES.(NIVEL II).
-LA ADICION DE UNA FUSION POSTEROLATERAL A UNA FUSION INTERSOMATICA NO ES
RECOMENDADA PORQUE LA EVIDENCIA CLINICA NO REPORTA BENEFICIOS CLINICOS Y SI
AUMENTO DE LAS COMPLICACIONES(NIVEL II-III)

12. TIPOS DE FUSION LUMBAR
-ALIF
-TLIF
-PLIF
-LLIF
-TRANSPSOAS
-POSTEROLATERAL

13. VENTAJAS DE FUSION LUMBAR INTERSOMATICA
SOBRE FUSION POSTEROLATERAL
1-INJERTOS INTERSOMATICOS SON COMPRIMIDOS POR EL 80% DE LA CARGA AXIAL,MIENTRAS QUE
POSTEROLATERAL POR EL 20%(LEY DE WOLF).
2-LOS INJERTOS INTERSOMATICOS PUEDEN OCUPAR HASTA EL 90% DE LA SUPERFICIE
INTERVERTEBRAL,MIENTRAS QUE LOS INJERTOS POSTEROLATERALES OCUPAN EL 10%
3-EL ESPACIO INTERSOMATICO ES MAS VASCULAR QUE EL ESPACIO POSTEROLATERAL AUMENTANDO
LAS POSIBILIDADES DE FUSION.
4-EL INJERTO INTERSOMATICOPERMITEN MEJOR RESTAURACION DEL BALANCE CORONAL Y SAGITAL.
5-SE PUEDE COLOCAR EN EL ESPACIO INTERSOMATICO PROTEINA MORFOGENETICA.
6-LA DIFERENCIACION DE PSEUDOARTROSIS Y FUSION ES MAS FACIL EN LA FUSION INTERSOMATICA

14. CIRUGIA DE FUSION LUMBAR CIRCUNFERENCIAL
GRADOS DEMOSTRO SUPERIORIDAD CLINICA
DURANTE EL SEGUIMIENTO COMPARADA CON
FUSION POSTEROLATERAL
SPINE Volume 32, Number 22, pp 2405–2414 ©2007, Lippincott Williams & Wilkins, Inc. Circumferential Fusion Is
Dominant Over Posterolateral Fusion in a Long-term Perspective Cost-Utility Evaluation of a Randomized Controlled
Trial in Severe, Chronic Low Back Pain Rikke Soegaard, MPH,* Cody E. Bu¨nger, MD, DMSc,* Terkel Christiansen,
MSc,† Kristian Høy, MD,* Søren P. Eiskjaer, MD,* and Finn B. Christensen, MD, PhD, DMSc*

15. shofferman et al., 2001.spine. III
A prospective randomized comparison of ALIF+ transpedicular instrumentation+PLF
(360° fusion) to ALIF+transpedicular instrumentation w/o PLF (270° fusion) w/ an
average follow-up of 35 months.
There were significant postop improvements in pain & function in both groups w/o
significant differences in percentage solid ALIF.
The 270° fusion group had significantly less blood loss, shorter operative times,
shorter LOS, & lower professional fees.
Both the 360° & 270° fusions significantly reduce pain & improve function, & there
are no significant clinical differences btwn them.
There were shorter operating times, less blood loss, lower costs, & less utilization of
health care resources associated w/ the 270° fusions.

16. Cristenzen et at, 2002 II:
Prospective randomized clinical trial that was down- graded due to using only static
radiographs to evaluate fusion status. A prospective randomized clinical study
analyzed the effects of circumferential fusion using ALIF radiolucent carbon fiber
cages & titanium posterior instrumentation vs instrumented PLF (w/ pedicle
screws) w/ 2-yr follow-up.
The circumferential lumbar fusion group had a higher fusion rate w/ significantly
fewer reops, showed a tendency toward better functional outcome than the
instrumented PLF group.
The authors favored circumferential fusion as a definitive surgical procedure in
complex lumbar pathology involving major instability, flat back, & previous disc
surgery in younger pts, compared w/ PLF w/ pedicle screws

17. HISTORIA
--ALIF CAPENER 1930. ESPONDILOLISTESIS
2002 TAY BBQ SEMIN NEUROL. 22:22
--CLOWARD1950 PLIF.PRESERVAR FACETAS
J. neurosurgery 1953;10:154-158
--TLIF EVITA RETRACCION DE RAIZ NERVIOSA
BLUME, H G ET AT NEURO ORTHOP SURG 1981:2:171
HARM ET AT ORTHOP GRENZ 120:343-347.
--XLIF(TRANSPSOAS)
LUZ PIMENTA 2002
.THE SPINE JOURNAL JUL-AGOSTO 2006.VOLUME 6

18. OBJETIVOS
DESCOMPRESION DE ESTRUCTURAS NEUROLOGICAS
RECONSTRUCCION DE DEFORMIDAD ESPINAL.RECONSTRUCCION DE CONDICIONES DE CARGA
ANTERIOR(FISIOLOGICAS)
ESTABILIZACION.FUSION DE LA INESTABILIDAD

19. OPCIONES DE FUSION LUMBAR
INTERSOMATICA CIRCUNFERENCIAL
-ALIF MAS INSTRUMENTACION POSTERIOR.
-PLIF INSTRUMENTADO
-TLIF INSTRUMENTADO
-LLIF INSTRUMENTADO

20. CONTRAINDICACIONES
DESTRUCCION OSEA
OSTEOPOROSIS SEVERA.USO DE CEMENTO
INFECCION.ESPONDILODISCITIS

21. INDICACIONES
-ESPONDILOLISTESIS
-DDD CON DOLOR DISCOGENICO
-HERNIA DISCAL LUMBAR RECURRENTE CON SIGNIFICATIVO DOLOR AXIAL
-COLAPSO DISCAL POSDISECTOMIA CON ESTENOSIS FORAMINAL Y RADICULOPATIA
-3ERA RECURRENCIA DISCAL O MAYOR RECURRENCIA DISCALCON RADICULOPATIA CON O SIN
LUMBAGO
-TRATAMIENTO DE PSEUDOARTROSIS
MANEJO DE CIFOSIS POSLAMINECTOMIA
-TRATAMIENTO DE DEFORMIDAD LUMBAR CON DEFORMIDAD CORONAL Y SAGITAL

22. PLIF TLIF ALIF
Inestabilidad degenerativa sin estenosis + ++ +++
inestabilidad degenerativa con estenosis +++ +++ +
Sindrome posdisectomia + ++ +++
Espondilolistesis litica(bajo grado) +++ + +++
Espondilolistesis litica (alto grado) +++ + -
Escoliosis degenerativa ++ ++ +++
Osteoporosis + + +++
Union lumbosacra + + +++

23. J neurosurgical spine.21:67-74.2014
Guideline update for the performance of fusion procedures for degenerative disease of the
lumbar spine. Part II: Interbody techniques for lumbar fusion Praveen V. Mummaneni, M.D.,1
Sanjay S. Dhall, M.D.,1 Jason C. Eck, D.O., M.S., 2 Michael W. Groff, M.D.,3 Zoher Ghogawala,
M.D.,4 William C. Watters III, M.D.,5 Andrew T. Dailey, M.D.,6 Daniel K. Resnick, M.D.,7 Tanvir F.
Choudhri, M.D.,8 Alok Sharan, M.D.,9 Jeffrey
There is no conclusive evidence supporting better clinical or radiographic outcomes based on
technique when performing interbody fusion.

24. PLIF
ABORDAJE LINEA MEDIA(LAMINECTOMIA O LAMINOTOMIA)
SUPERFICIE POSTEROLATERAL DEL DISCO(RETRACCION DEL SACO Y RAICES
NERVIOSAS)
DISECTOMIA
PREPARACION DE PLATAFORMAS VERTEBRALES(PARA FUSION)
RESTABLECIMIENTO DE LA ALTURA DISCAL
COMPRESION DEL ESPACIADOR INTERSOMATICO
INSTRUMENTACION PEDICULAR.+-FUSION POSTEROLATERAL

26. Journal of Neurosurgery: Spine
July 2007 / Vol. 7 / No. 1 / Pages 21-26
CLINICAL ARTICLESComparison of anterior- and posterior-approach instrumented lumbar
interbody fusion for spondylolisthesis
Jun-Hong Min, M.D., Ph.D.1, Jee-Soo Jang, M.D., Ph.D.1, and Sang-Ho Lee, M.D., Ph.D.2
Abbreviations used in this paper: ALIF = anterior lumbar inter-body fusion; ASD = adjacent-
segment Abstract
OBJECT
The purpose of this study was to compare the imaging and clinical outcomes obtained in patients
with lumbar spondylolisthesis who have undergone either instrumented anterior lumbar interbody
fusion (ALIF) or instrumented posterior LIF (PLIF), especially with regard to the development of
adjacent-segment degeneration (ASD).
.
RESULTS
Adjacent-segment degeneration was found in 44.0% of the patients in the ALIF group and in 82.6%
of those in the PLIF group (p = 0.008). Clinical success rates were 92.0 and 87.0% in the ALIF and
PLIF groups, respectively. There were no statistically significant intergroup differences in the
postoperative segmental and lumbar lordosis, postoperative percentage of slippage, reduction
rate, Japanese Orthopaedic Association score, and success rate.
CONCLUSIONS
Both ALIF and PLIF can produce good outcomes in treating lumbar spondylolisthesis, but ALIF is
more advantageous in preventing the development of ASD.

27. TLIF
ABORDAJE DORSOLATERAL A LA FACETA Y LAMINA(RESECCION FACETA
ARTICULAR)
DESCOMPRESION DE CANAL ESPINAL?
DISECTOMIA
PREPARACION DE PLATAFORMAS ARTICULARES PARA FUSION
REESTABLECIMIENTO DE LA ALTURA DISCAL
COMPRESION DEL ESPACIADOR INTERSOMATICO
COLOCACION DE CAJA CON ROTACION IN SITU
MIS INSTRUMENTACION
INSTRUMENTACION PEDICULAR.

28. February 2010 / Vol. 12 / No. 2 / Pages 171-177
Journal of Neurosurgery: Spine
ARTICLEWhich lumbar interbody fusion technique is better in terms of level for the treatment of unstable isthmic
spondylolisthesis?
Clinical article
Jin-Sung Kim, M.D., Kil-Yong Lee, M.D., Sang-Ho Lee, M.D., Ph.D., and Ho-Yeon Lee, M.D., Ph.D.
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
The purpose of this study was to investigate and compare clinical and radiographic outcomes of 2 kinds of lumbar
interbody fusion (LIF) for the treatment of adult low-grade isthmic spondylolisthesis at L4–5 and L5–S1 levels.
RESULTS
In both groups, VAS and ODI scores had significantly improved at both treatment levels. Statistical analysis showed no
significant difference in postoperative VAS scores between groups at the L4–5 level and in postoperative VAS/ODI scores
at the L5–S1 level. However, ODI scores were better in the TLIF than in the ALIF group at the L4–5 level. In terms of
radiological changes, there were no significant differences between the 2 groups at the L4–5 level; however, at the L5–S1
level, radiographic results indicated that ALIF was superior to TLIF. The radiological evidence of fusion shows no
intergroup difference and no interlevel difference.
CONCLUSIONS
Considering the clinical and radiological outcomes in both groups, the authors recommend that instrumented mini-TLIF is
preferable at the L4–5 level, whereas instrumented mini-ALIF might be preferable at the L5–S1 level for the treatment of
unstable isthmic spondylolisthesis.

29. Journal of Neurosurgery: Spine
October 2007 / Vol. 7 / No. 4 / Pages 379-386
CLINICAL ARTICLESAnterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion:
implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance.,
Tyler R. Koski, M.D., Patrick C. Hsieh, M.D.,Stephen Ondra, M.D., and Patrick Sugrue, M.D., Sean Salehi,M.DJohn
C. Liu, M.D.
Department of Neurological Surgery, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern
University, Chicago, Illinois
METHODS
The medical records and radiographs of 32 patients undergoing ALIF and 25 patients undergoing TLIF from RESULTS
Our results indicate that ALIF is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar
lordosis. The ALIF procedure increased foraminal height by 18.5%, whereas TLIF decreased it by 0.4%. In
addition, ALIF increased the local disc angle by 8.3° and lumbar lordosis by 6.2°, whereas TLIF decreased the local disc
angle by 0.1° and lumbar lordosis by 2.1°.
CONCLUSIONS
The ALIF procedure is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis.
The improved radiographic outcomes may be an indication of improved sagittal balance correction, which may lead to
better long-term outcomes as shown by other studies. Our data, however, demonstrated no difference in clinical
outcome between the two groups at the 2-year follow-up.

31. PLIF VS TLIF
DISTRACCION BILATERAL OPTIMA
DESCOMPRESION CONTROLADA DIRECTA
MAS COMPLICACIONES NEUROLOGICAS,ESPECIALMENTE EN REVISION
DAÑO BILATERAL A LA COLUMNA POSTERIOR
POSICION INFERIOR DEL INJERTO(CAJA TLIF MAS ANTERIOR,MEJOR LORDOSIS)
NO OPCION DE MIS

32. BIOMECANICA
GRADO DE FUSION ENTRE 74-94 %
EVOLUCION FAVORABLE :80 %
NO HAY BUENA CORRELACION ENTRE FUSION Y EVOLUCION
PEEK VS TITANIUM

33. COMPLICACIONES
LESION RADICULAR
RADICULOPATIA CRONICA(FIBROSIS ENDONEURAL POR RETRACCION)
DISLOCACION DEL IMPLANTE
MALA COLOCACION DEL IMPLANTE
PSEUDOARTROSIS
INFECCION,MORBILIDAD DEL SITIO DONADOR ETC

34. MINI TLIF(PRO Y CONTRAS)
MENOR DAÑO MUSCULAR(ABORDAJE DE WILTSE)
INSTRUMENTACION PERCUTANEA
LESION NERVIOSA IPSILATERAL(DOLOR NEUROPATICO)
DESCOMPRESION INSUFICIENTE/LESION DE RAIZ NERVIOSA
CONTRALATERAL.
MENOS OPTIMA REDUCCION DE ESPONDILOLISTESIS
MENOR CONTACTO IMPLANTE-HUESO

36. MINITLIF VS TLIF
RESULTADOS DE FUSION SIMILARES
MENOS PERDIDA DE SANGRE.MENOR ESTANCIA HOSPITALARIA.
CURVA DE APRENDIZAJE CON MAYORES COMPLICACIONES NEUROLOGICAS
MAYOR PORCIENTO DE FALLO DEL SISTEMA

37. ABORDAJE TRANSPSOAS
ABORDAJE LATERAL EXTRAPERITONEAL
TRANSPSOAS/PARAPSOAS
NEUROMONITOREO
INDICACIONES:OSTEOCONDROSIS(DDD)
REVISION DEPUES DE UN TRD O LIF
ESCOLIOSIS DEGENERATIVA

39. ANATOMIA XLIF

40. TECNICA

41. PRO Y CONTRAS
GRAN SUPERFICIE DE CONTACTO
NO DESNERVACION DE LA MUSCULATURA DORSAL
MIS
NO DESCOMPRESION DIRECTA
DEBILIDAD TEMPORAL DEL MUSCULO PSOAS/DEBILIDAD DEL PLEXO.
CONSUME TIEMPO(SUPLEMENTADA POR ABORDAJE VIA POSTERIOR)
DIFICIL REPOSICIONAR ESPONDILOLISTESIS

42. ALIF

43. Eur Spine J. 2011 Aug;20(8):1323-30. doi: 10.1007/s00586-011-1782-x. Epub 2011
Apr 13.
Anterior interbody arthrodesis with percutaneous posterior pedicle fixation for
degenerative conditions of the lumbar spine.
Anderson DG1, Sayadipour A, Shelby K, Albert TJ, Vaccaro AR, Weinstein MS.
This is a retrospective case series to evaluate clinical variables, complications and
outcome of 50 patients who underwent anterior lumbar interbody fusion (ALIF)
supplemented with posterior percutaneous pedicle screw.
This study found that ALIF using allograft bone and rhBMP-2 combined with
percutaneous pedicle screw fixation had a high fusion rate and a low incidence of
perioperative complications. Patient outcomes showed significant improvements
in back and leg pain and physical functioning.

44. Global Spine J. 2012 Dec;2(4):195-206. doi: 10.1055/s-0032-1329892. Epub 2012
Nov 19.
A radiological comparison of anterior fusion rates in anterior lumbar
interbody fusion.
McCarthy MJ1, Ng L2, Vermeersch G2, Chan D2.
To compare anterior fusion in standalone anterior lumbar interbody fusion (ALIF)
using cage and screw constructs and anterior cage-alone constructs with posterior
pedicle screw supplementation but without posterior fusion.
Conclusion Posterior pedicle screw supplementation without
posterolateral fusion improves the fusion rate of ALIF when using anterior cage and
screw constructs. We would recommend supplementary posterior fixation
especially in cases where more than one level is being operated.

45. Good outcome and restoration of lordosis after anterior
lumbar interbody fusion with additional posterior
fixation.
avlov PW; Meijers H; van Limbeek J; Jacobs WC; Lemmens JA; Obradov-Rajic M; de Kleuver M.
Spine. 29(17):1893-9; discussion 1900, 2004 Sep 1.
[Clinical Trial. Journal Article]
Pavlov, Paul W; Meijers, Hjalmar; van Limbeek, Jaques; Jacobs, Wilco C H; Lemmens, J Albert M; Obradov-Rajic,
Marina; de Kleuver, Marinus.
Fifty-two patients with degenerative disc disease underwent single- or double-
level anterior lumbar interbody fusion with SynCage and additional posterior fixation as treatment for
degenerative disc disease and were prospectively followed for 4 years.
CONCLUSIONS: Anterior lumbar interbody fusion withSynCage and additional posterior fixation is a safe and
effective procedure. Intervertebral height is corrected, and lumbosacral lordosis is restored. An initial
improvement in VAS and Oswestry scores is partly lost at the 4-year follow-up observation, but 4-year results
are still significantly better than the preoperative scores.

48. PEEK Cages in Lumbar Fusion: Mid-term Clinical
Outcome and Radiologic Fusion.
Schimmel JJ; Poeschmann MS; Horsting PP; Schonfeld DH; van Limbeek J; Pavlov PW.
Clinical Spine Surgery : A Spine Publication. 29(5):E252-8, 2016 Jun.
[Journal Article]
Schimmel, Janneke J P; Poeschmann, Marcel S; Horsting, Philip P; Schonfeld, Dirk H W; van Limbeek, Jacques;
Pavlov, Paul W.
DATA: Anterior lumbar interbody fusion can be a good alternative in chronic low back pain when conservative
treatment fails. Although titanium alloy cages give good fusion rates, disadvantages are the subsidence of the
cage in the adjacent vertebrae and problematic radiologic evaluation of fusion. PEEK cages such as the Synfix-LR
cage (Synthes, Switzerland) .
CONCLUSIONS: A high number of reoperations after an anterior lumbar interbody fusion procedure with the
Synfix-LR cage were found, mainly because of symptomatic pseudarthrosis. The absence of posterior fixation in
combination with lower stiffness and the hydrophobic characteristics of PEEK probably lead to insufficient initial
stability, creating suboptimal conditions for bony bridging, and thus solid fusion.

50. Revision strategies for lumbar pseudarthrosis.
Etminan M1, Girardi FP, Khan SN, Cammisa FP Jr.
Revision surgery for pseudarthrosis remains costly and complicated. Local and
systemic factors should be corrected or improved before further surgery is
performed.
Pseudarthrosis is still one of the most difficult conditions to assess as a source of
symptoms, and not surprisingly the outcome from repair of pseudarthrosis is the
most difficult to predict.
After determining the presence of pseudarthrosis and ascertaining through
clinical examination and evaluation the level of symptomatic pseudarthrosis,
operative intervention may be considered once conservative management has
failed.
Posterior procedures for revision of a failed lumbar fusion have not yielded
reliably successful results; however, this approach does have a significant role in
the appropriately selected candidate.
A combined anteroposterior approach may be more effective in restoring sagittal
balance and enhancing fusion rates.
The use of posterior instrumentation in light of an anterior pseudarthrosis or
anterior support in light of a posterior pseudarthrosis is a viable option for
treatment in these circumstances.

51. Global spine j.febrero 2016
Anterior Lumbar Interbody Fusion as a Salvage Technique for Pseudarthrosis
following Posterior LumbarFusion Surgery.
Mobbs RJ1, Phan K1, Thayaparan GK2, Rao PJ1.
Author information
Abstract
Study Design Retrospective analysis of prospectively collected observational
data. Objective To assess the safety and efficacy of anterior lumbar
interbody fusion (ALIF) as a salvage option for lumbar pseudarthrosis following
failed posterior lumbar fusion surgery.
Conclusions Overall, our results suggest that the ALIF procedure results not
only in radiographic improvements in bony fusion but in significant
improvements in the patient's physical and mental experience of pain secondary
to lumbar pseudarthrosis. Future multicenter registry studies and randomized
controlled trials should be conducted to confirm the long-term benefit of ALIF as
a salvage option for failed posterior lumbar fusion.

52. CONCLUSIONES
1-LA FUSION SOMATICA LUMBAR CIRCUNFERENCIAL NOS PERMITE EL MANEJO INTEGRAL DE
PATOLOGIAS COMPLEJAS DE LA COLUMNA LUMBAR.
2-ES IMPORTANTE TENER UN ENTRENAMIENTO ADECUADO QUE NOS PERMITA ABORDAR DE
FORMA ANTEROLATERAL EL DISCO LUMBAR.
3-EL ANALISIS ADECUADO DEL BALANCE SAGITAL DEL PACIENTE ES IMPERATIVO PARA LOGRAR
BUENOS RESULTADOS A LARGO PLAZO.
4-LA EXPERIENCIA Y PREFERENCIA DEL CIRUJANO DETERMINAN CUAL TECNICA
EMPLEAR,AUNQUE EXISTEN GUIAS QUE NOS AYUDAN A SELECCIONAR CUAL TECNICA ES LA MAS
ADECUADA SEGÚN LA PATOLOGIA A TRATAR