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49 Executive Briefing: Medial Lumbar Interbody Fusion: A Different Approach to Posterior Fusion By Dwight Tyndall, MD, Orthopaedic Specialists of Northwest Indiana P ressures from patients and the healthcare system at large for shorter hospi- talization, quicker return to function and reduced overall expense demand that today's spine surgeon develop expertise in anat- omy-conserving surgical techniques. The conserva- tion of anatomy by limiting incision, dissection and retraction can reduce postoperative morbidity and profoundly impact these metrics. An evolving anatomy conserving stabilization method which uses a small midline incision, interbody fusion, and a divergent, corticocancellous screw trajecto- ry has been gaining in popularity. This increase in popularity can be attributed to nu- merous factors, including: 1. Stabilization quality: The use of interbody fusion provides excellent anterior column support and the screw trajectory engages more cortical bone than tradi- tional approaches. 2. Decompressive access: The procedure is done through a midline (laminectomy) exposure and provides excellent visualization of all neural anatomy. 3. Anatomy conservation: Construct assembly can be completed within the confines of a typical laminectomy exposure; no additional exposure for the fusion con- struct is required. This greatly limits incision size, dissec- tion and retraction. 4. Procedural efficiency: Limiting dissection and im- proving decompression visibility can greatly decrease procedure time. In addition to being beneficial for the patient, this can benefit all aspects of healthcare delivery. Day surgery application is also possible. 5. Broad utility: As a result of the direct decompressive access and the quality of the stabilization achieved, this technique is applicable to most lumbar fusions. Due to these advantages, I have altered my preferred fusion methodology and have experienced what I con- sider to be good to excellent clinical results. In my own practice, I have experienced a reduction in postoperative morbidity leading to a reduction in hospital stay from three days to one day. The technology Using divergent screw trajectories causes the screw Sponsored by: TM Patient treated with MediaLIF construct Posterior Spinal Fusion