Current concepts on spinal arthrodesis in degenerative disorders of the lumbar spine

Table 1 Advantages and disadvantages of current procedures for the treatment of degenerative disorders of the lumbar spine

Surgical technique	Advantages	Disadvantages
ALIF	Direct visualization of disc space	Intra-abdominal vascular and visceral injury[31,32]
	Small incisions and reduced tissue invasiveness if minimally invasive approach performed[27-30]
PLIF	Avoiding intra-abdominal complications associated with anterior approach	Increased risk of surgical damage to neural structures, dural layer, and epidural veins[33-35]
LLIF	Avoiding surgical complications associated with anterior and posterior approaches	Limited surgical accessibility of L5-S1 level due to iliac crest
	Sparing of anterior longitudinal ligament (ligamentotaxis)[36]	Injury to lumbar plexus during transpsoas approach with post-operative approach-related neurological deficits[37-40]
	Stable implantation of device due to bilateral utilization of the dense apophyseal ring[36]
TLIF	Minimally-invasive	Less reduction in ROM compared to LLIF, if performed as stand-alone procedures[41]
	Reduced nerve root retraction[41]
	Circumferential fusion[27,41-43]
Total disc arthroplasty	Reduced risk of adjacent segment disease due to preservation of motion[47]	Narrow spectrum of indications[48,49]
	No fusion required[47]
Nucleus replacement	Preservation of motion	Risk of device migration, extrusion, and subsidence[53,54]
	Multiple approach and revision options[53]
Sublaminar wiring	Can be implanted as an adjunct to other devices (hybrid)[4]	Risk of neurological injury[58,59]
Pedicle screws	Involvement of all three columns[4]	High costs[4]
	Rigid segmental fixation[4]	Damage to neural and vascular structures[4]
	High fusion rates[4]	Adjacent segment disease[62]
	Adequate deformity correction[4]
	Percutaneous approach possible[65-67]
Translaminar screws	Minimally-invasive percutaneous approach available[4,68,69]	Not indicated for multilevel arthrodesis[4,68,69]
Facet arthroplasty	Preservation of motion	Complex anatomy of facet joints
	Reduce the risk of adjacent segment disease[71]	Narrow spectrum of indications
Interspinous implants	Preservation of motion	Narrow spectrum of indications

ALIF: Anterior lumbar interbody fusion; PLIF: Posterior lumbar interbody fusion; LLIF: Lateral lumbar interbody fusion; TLIF: Transforaminal lumbar interbody fusion; ROM: Range of motion.