Uninstrumented Posterior Lumbar Interbody Fusion: Have Technological Advances in Stabilizing the Lumbar Spine Truly Improved Outcomes?

Background: Since the 1980s, numerous operations have replaced posterior lumbar interbody fusion (PLIF) with human bone. These operations often involve expensive implants and complex procedures. Escalating expenditures in lumbar fusion surgery warrant re-evaluation of classical PLIF with allogeneic ilium and without instrumentation.

The use of bone grafts and alloplastic materials in cranioplasty.

Trephination dates from prehistoric neolithic times (10,000-7000 B.C.) and is the oldest operation known.

Toward uniformity in evaluating results of lumbar spine operations. A paradigm applied to posterior lumbar interbody fusions.

Criteria for evaluating the results of treating lumbar spinal disorders vary widely. Comparative analyses of outcome among different therapy protocols are compromised by the diversity among the groups studied, as well as by the varying methods of measuring success. A rating scale is proposed based on the economic and functional status of the patient before and after treatment; anatomic results can be correlated.

Quantitative comparisons of healing in cranial fresh autografts, frozen autografts and processed autografts, and allografts in canine skull defects.

Adult dog skull defects larger than 17 mm do not spontaneously heal. A quest for a potentially viable, cosmetically, mechanically, and technically acceptable template for human cranial reconstruction prompted a comparison of processed autogeneic and allogeneic bone implants with a fresh autograft control in the dog. Quantitative reproducible observations demonstrated that fresh calvarial bone autografts were superior to the nonviable implants in volume percent defect filled, mm2 new cortical bone, mm2 new and old cortical bone, and cortical bone porosity.