• Christopher P Ames, Frank L Acosta, John Chi, Jaicharan Iyengar, William Muiru, Emre Acaroglu, and Christian M Puttlitz.
• Department of Neurological Surgery, University of California, San Francisco, CA 94143-0112, USA. amesc@neurosurg.ucsf.edu
• Spine. 2005 Oct 1; 30 (19): E562-6.

Study DesignBiomechanical laboratory study of human cadaveric spines.ObjectiveTo determine the difference in acute stability between posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) performed at 1 and 2 levels with and without posterior fixation.Summary Of Background DataCircumferential spinal fusion with both an interbody graft and posterior pedicle screw-rod construct has been advocated to decrease pseudarthrosis rates. Both PLIF and TLIF theoretically allow for 3-column fixation and fusion.MethodsSpecimens underwent either PLIF or TLIF at L2-L3 (single-level) and L3-L4 (2-level), both with and without pedicle screw instrumentation. During TLIF, an interbody allograft was placed in the anterior or middle column. Nondestructive, nonconstraining pure moment loading was applied to each specimen.ResultsThere were no significant differences in the range of motion after either PLIF or TLIF at 1 level. The addition of pedicle screws tended more strongly to increase rigidity after 1-level PLIF compared to TLIF. Position of the TLIF graft did not affect stability. The addition of pedicle screws to a 2-level construct significantly reduced all motions tested.ConclusionsBased on our findings, posterior fixation with a pedicle screw-rod construct is suggested for 1-level PLIF and TLIF, and is necessary to achieve stability after interbody fusion across 2 levels using either technique.

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