LAUSR

Posterior lumbar interbody fusion allows for direct decompression of the neural elements and interbody fusion through the same incision [1]. It avoids the morbidity associated with anterior approach and minimizes significant risk of major vascular or visceral injury and sexual dysfunction in males [2]. Obesity, becoming increasingly common, is a relative contraindication for anterior approach. The technique of PLIF was made popular by Cloward in 1953 where he used iliac crest graft for interbody fusion [3]. Modern PLIF involves insertion of two cages made of PEEK or titanium packed with bone graft for interbody fusion. This is always coupled with pedicle screw instrumentation for rigid stability [4, 5]. The window of cage insertion in the PLIF is through the posterior disc after retraction of the traversing nerve root medially. This is performed on both sides, in comparison to the TLIF where a single cage is inserted unilaterally through the window, which is into the neural foramen between the exiting and the traversing nerve roots [6]. Common indications of PLIF include degenerative spondylolisthesis, symptomatic spinal stenosis with discogenic back pain. Addition of graft in the postero-lateral bed allows 360 fusion and increases fusion rates.