A microsurgical technique for posterior lumbar interbody fusion: technical note.

Abstract

To describe a microsurgical modification of the Ray Threaded Fusion Cage (TFC) instrumentation technique for achieving lumbar interbody fusion. The lumbar fusion is established by application of two titanium cages through two different short skin incisions, first on one and then on the other side. The spinous processes and the whole interspinous ligament are preserved. Under microscopic control, the lower nerve root and foramen are identified and foraminotomy performed. The dural sac is carefully exposed so that a free and gentle retraction of the nerve root to the midline can be obtained. After removal of the disc material, the retractor is inserted. Special attention should be paid to visualization of the superior nerve root in order to avoid neural injuries. The end plate and disc material are then drilled and tapped for insertion of the appropriate cage. The Ray TFC lumbar fusion can be practically and safely performed under microscopic control.