Anterior Posterior Fusion and the Management of Lumbar Instability

Anterior-posterior surgery is indicated for the treatment of lumbar instability in the presence of simultaneous compromise of both the anterior and the posterior spinal elements or to augment the stability and rigidity of a fusion construct. The addition of an anterior interbody fusion to a posterior instrumented fusion serves to more successfully restore sagittal balance, effect indirect neural decompression, and to decrease pedicle screw strain by reconstituting the load-sharing ability of the anterior column. A variety of posterior fixation and minimally invasive techniques has been demonstrated to increase circumferential construct stiffness and rates of fusion.