Clinical and Radiological Comparison of Posterolateral Fusion and Posterior Interbody Fusion Techniques for Multilevel Lumbar Spinal Stabilization In Manual Workers

Abstract

Study DesignEighty-four patients who had been treated for degenerative spinal diseases between January 2006 and June 2009 were reviewed retrospectively.PurposeWe aimed to compare the clinical and radiologic findings of manual workers who underwent posterolateral fusion (PLF) or posterior interbody fusion (PLIF) involving fusion of 3 or more levels of the spine.Overview of LiteraturePrevious studies have concluded that there is no significant difference between the clinical outcome of PLF and PLIF techniques.MethodsAfter standard decompression, 42 patients underwent PLF and the other 42 patients underwent PLIF. Radiologic findings, Oswestry disability index (ODI) scores, and visual analogue scale (VAS) scores were assessed preoperatively and at 6-month intervals postoperatively and return to work times/rates were assessed for 48 months.ResultsPatients who underwent PLF had significantly shorter surgical time and less blood loss. According to the 48-month clinical results, ODI and VAS scores were reduced significantly in the two groups, but the PLIF group showed better results than the PLF group at the last follow-up. Return to work rate was 63% in the PLF group and 87% in the PLIF group. Union rates were found to be 81% and 89%, respectively, after 24 months (p=0.154).ConclusionsPLIF is a preferable technique with respect to stability and correction, but the result does not depend on only the fusion rates. Discectomy and fusion mass localization should be considered for achieving clinical success with the fusion technique. Before performing PLIF, the association of the long operative time and high blood loss with mortality and morbidity should be taken into consideration, particularly in the elderly and disabled patients.

Clinical Outcomes of Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion in Patients with Lumbar Spinal Stenosis and Degenerative Instability

“…The findings of our study showed that the improvement in LBP during the follow-up was significantly more in the patients who were operated on using PLF with posterior instrumentation than in the patients operated on with PLIF with posterior instrumentation and more LBP was seen in the patients of Group II after the operation. The results in our study are somewhat in contrast to other studies showing that there is a similar outcome between PLF and PLIF (13)(14)(15)(38)(39)(40)(41)(42)(43). Ekman et al (39) compare the outcome of PLIF and PLF in adult isthmic spondylolisthesis (IS) and reported that type of fusion, PLIF or PLF, does not affect the pain at 2 years after surgical treatment of adult IS.…”

“…Lidar et al (42) reported that there was no difference regarding VAS between the 2 groups. However, in contrast to our findings, some studies have reported that PLIF provides more reduction in VAS than PLF (15,43). In 2015, Alijani et al (15) evaluated and compared the pain of patients with spondylolisthesis who had undergone either PLF or PLIF and they reported that PLIF was related to better outcome with respect to pain control at 6 month after the surgery than PLF.…”

“…In 2015, Alijani et al (15) evaluated and compared the pain of patients with spondylolisthesis who had undergone either PLF or PLIF and they reported that PLIF was related to better outcome with respect to pain control at 6 month after the surgery than PLF. Similarly, Aygün et al (43) reported that at 48 months after the surgery, PLIF group showed better results regarding VAS than the PLF group. The difference between Aygün et al's findings (43) with our findings might be due to their longer follow-up period that was twice more than that of our study.…”

“…Similarly, Aygün et al (43) reported that at 48 months after the surgery, PLIF group showed better results regarding VAS than the PLF group. The difference between Aygün et al's findings (43) with our findings might be due to their longer follow-up period that was twice more than that of our study.…”

Low-grade spondylolisthesis: is transforaminal lumbar interbody fusion superior to posterolateral fusion

“…Radiographic fusion was assessed using plain radiographs by Lenke classification for PLF and by Brantigan, Steffee, Fraser (BSF) classification for TLIF group. 11…”