الفهرس 
Literature ReviewOnly 14 pages are availabe for public view
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Abstract
Proper diagnosis and well planed surgery are key factors for achieving successful outcomes.
Patients suffering from a painful lumbar motion segment that is refractory to o conservative management gain benefit from instrumented 360 PLIF.
This surgical procedure improves the back pain and disability as well as achieving high fusion rates.
Trabecular metal (TM) interbody devices support the anterior vertebral column, restore the disc height and maintain the foraminal height without developing subsidence.
Its unique trabecular structure allows for bone ingrowth within these implants and in-between the two end plates.
They also add initial stability and maintain the sagittal lumbar alignment reducing the risk of lost lordosis or developing kyphosis throughout the follow up.
Adding synthetic bone substitute (Actifuse) within the disc space and careful preparation of end plates provide almost optimal biological media for the fusion to occur.
Actifuse also eliminates the risk of donor site morbidity which is common with iliac crest grafting and reduces the operative time and blood loss.
Spinal fusion field continues to evolve with new technologies in instrumentation, minimal access techniques, interbody spacer options and the use of rhBMP.
More studies are required to determine whether the benefits of techniques that are less invasive and more expensive outweigh their associated risks.
The modern spine surgeon should be proficient in using the broad range of surgical tools at his/her disposal in order to best address the painful motion segment.