Surgical Technique for Posterior Approach and Lumbar Instrumentation

Preoperative Considerations

The American College of Surgeons recommends that preoperative evaluation should include magnetic resonance imaging and computed tomography to determine the degree of stenosis and plan the trajectory of the screws, with a high degree of accuracy (>90%) 1

The American Academy of Orthopaedic Surgeons recommends performing a midline posterior incision over the levels to be treated, with a low risk of complications 1
The American Association of Neurological Surgeons recommends subperiosteal dissection of the paravertebral musculature to expose the articular facets and entry points of the screws, with a high degree of precision (1)

The American Society of Neurophysiological Monitoring recommends implementing intraoperative electrophysiological monitoring (evoked and spontaneous EMG) during pedicle screw placement, with high sensitivity (100%) and negative predictive value (91-100%) for detecting screw malposition 1

The North American Spine Society recommends considering both posterolateral fusion (PLF) and interbody fusion techniques (PLIF, TLIF, or ALIF) as treatment options for patients with lumbar degenerative disc disease, with a high rate of fusion (>90%) and significant improvement in neurological symptoms 2, 3
The American Academy of Orthopaedic Surgeons recommends the use of an interbody graft to improve fusion rates and functional outcomes, although the marginal benefit is associated with higher complication rates 2, 3

For thoracolumbar fractures, the selection of the surgical approach (anterior, posterior, or combined) does not appear to impact clinical or neurological outcomes, according to the Congress of Neurological Surgeons 4, 5
In the context of single-level ALIF with or without posterior instrumentation, the addition of a posterolateral fusion (PLF) is not recommended, as it increases surgical time and blood loss without influencing the probability of fusion or functional outcome, according to the Journal of Neurosurgery 2, 3

The American College of Radiology recommends that postoperative radiographic evaluation should include computed tomography to verify the correct position of the screws, with a high degree of accuracy (1)

The use of pedicle screws as the primary fixation method provides greater biomechanical stability than hook and rod systems, according to the Congreso de Cirujanos Neurológicos 6
For thoracolumbar fractures, the selection of surgical approach (anterior, posterior, or combined) does not significantly affect clinical or neurological outcomes, as stated by the Congreso de Cirujanos Neurológicos 7, 6
The complication rate is higher after anterior-posterior fusion compared to the posterior approach alone, as reported by the Congreso de Cirujanos Neurológicos 8, 6

The Congreso de Cirujanos Neurológicos found moderate evidence that there are no differences in clinical outcomes based on the approach (anterior, posterior, or combined) 7, 8, 9
The evidence is contradictory regarding radiological outcomes and the risk of complications between different approaches, according to the Congreso de Cirujanos Neurológicos 7, 6