Study Design. This is a retrospective study of 42 patients having lumbar degenerative disease or spondylolytic spondylolisthesis treated by posterior lumbar interbody fusion (PLIF) using local autogenous facet joint graft and pedicle screw fixation with an average follow-up time of 8.5 years.

Objectives. To evaluate the radiographic and clinical results of patients treated with PLIF using adjacent facet joint autograft and pedicle screw internal fixation.

Summary of Background Data. Some goals of spinal surgery have been achieved by interbody arthrodesis using a posterior approach popularized by Cloward. However, significant problems including bone graft collapse, resorption, nonunion, persistent neurologic compression, and iliac crest donor complication using the classic PLIF remain. There are few reports describing the results of a PLIF by total facet joint excision.

Methods. Forty-two patients (average, 53.2 years) treated at our institution with PLIF by total facetectomy were followed for an average period of 8.5 years. The changes in the Japanese Orthopedic Association score, the recovery rate, complications, and radiographic findings were evaluated.

Results. Good radiographic fusion (92.9%) and clinical results (postoperative recovery rate of 76% in the Japanese Orthopedic Association score) were achieved by PLIF using local facet joint autograft and pedicle screw fixation in treating patients with debilitating lumbar degenerative disease. The complications related to the operative procedure occurred in three patients of delayed union.

Conclusions. For lumbar degenerative diseases with osteophytic changes of facet joints, PLIF using pedicle screw fixation and local autogenous bones obtained from facet excision may be justified as a treatment opinion. The procedure as described offers advantages for spinal surgery when PLIF is warranted.

In a society composed of increasing numbers of elderly people, the treatment of debilitating lumbar degenerative diseases with segmental instability is becoming a major challenge for those treating spinal disorders. Good results have been reported with an interbody arthrodesis using a posterior approach (posterior lumbar interbody fusion, PLIF) popularized by Cloward. 1,2 However, others 3–10 have noted failure of fusion and residual neurologic compromise not resolved with the classic Coward PLIF. Obtaining bone from the iliac crest has several disadvantages, including increased operative time, blood loss, soft tissue dissection, and postoperative pain. The fragile, weakened iliac bone of elderly patients with osteopenia has a high potential for graft collapse, loss of disc space height, failure of fusion, and persistent neurologic impingement. Decompression of the narrowed neuroforamen and lateral canal by enlarged osteoarthritic facet joints is limited using the standard laminectomy. 6,8,11,12 Failure to thoroughly decompress the neural foramen can be a cause of residual pain after surgery. 11,13,14 Indications and strategies of treatment for lumbar degenerative disease are to decompress the neural elements, assure spinal stability, and avoid excessive soft tissue dissection.

Since 1990, the authors have performed PLIFs using strut cortical bone grafts obtained by local total facetectomy. The objectives of this study were to clarify the use of this operative procedure of PLIF and to analyze the postoperative results, including complications, radiographic fusion rate, and clinical status of patients followed for an average 8.5 years.