Posterior lumbar interbody fusion versus posterolateral fusion with instrumentation in the treatment of low-grade isthmic spondylolisthesis: midterm clinical outcomes

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The purpose of this study was to compare the methods of posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) in cases of isthmic Grades 1 and 2 lumbar spondylolisthesis, and to evaluate the clinical efficacy of the procedures.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Operations were performed in 50 patients with lumbar spondylolisthesis in the authors' clinics between 2001 and 2007. Indications for surgery were low-back pain with or without sciatica and neurogenic claudication that had not improved after at least 6 months of conservative treatment. The study included 33 female and 17 male patients, with mean ages of 50.6 years in the PLIF group and 47.3 years in the PLF group.</jats:p> <jats:p>These patients were randomly allocated into 2 groups: decompression, posterior transpedicular instrumentation, and PLF (Group 1; 25 patients) and decompression, posterior transpedicular instrumentation, and PLIF (Group 2; 25 patients). In the PLIF group, titanium cages were used, and autograft material was obtained from the decompression. In the PLF group, bone fragments collected from the iliac crest were used as autografts. A minimum 18-month follow-up was available in all patients. For clinical evaluation, a visual analog scale, Oswestry Disability Index, and the 36-Item Short Form Health Survey were used. Improvements in pre- and postoperative spondylolisthesis, segmental angles, fusion ratios, and postoperative complications were evaluated radiologically.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The average follow-up period was 3.3 years. Based on the etiologies, isthmic spondylolisthesis was detected in all patients. The spondylolisthesis levels in the patients who underwent PLIF were located at L3–4 (5 patients, 20%); L4–5 (14, 56%); and L5–S1 (6, 24%), whereas the levels in the ones treated with PLF were located at L3–4 (4 patients, 16%); L4–5 (13, 52%); and L5–S1 (8, 32%). In the clinical evaluations, good or excellent results were obtained in 22 (88%) cases in the PLIF group and 19 (76%) cases in the PLF group. Fusion ratios were 100% in the PLIF group and 84% in the PLF group. Both lumbar lordosis and the segmental angle showed greater improvement in the PLIF group. There was no difference in the complication rates for each group.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Based on early clinical outcomes and the fusion ratios of adult isthmic spondylolisthesis, the authors found PLIF to be superior to PLF.</jats:p></jats:sec>

Short and Medium Term Results of Posterior Segmental Instrumentation and Posterolateral Fusion in Female Patients with Spondylolisthesis: A Clinical Trial

“…When looking at the studies related to posterior fixation and fusion in the literature, a significant improvement was seen in VAS and ODI scores of patients in the early and medium term (18)(19)(20). In our study, when the ODI and VAS scores of the patients with fusion and non-fusion were compared in the preoperative and postoperative periods, the ODI and VAS scores were statistically significantly lower in the postoperative period than the preoperative period.…”

Management of Sports-Related Lumbar Conditions

“…Similarly, another study of 50 spondylolisthesis patients randomly allocated to posterolateral fusion and PLIF demonstrated a significantly higher rate of fusion (100%) in the PLIF group than the posterolateral group (84%). The authors also noted greater improvement in lumbar lordosis and segmental angle in the PLIF cohort 109 . A comparison of 122 patients undergoing either anterior interbody or posterolateral fusion found both techniques produced similar early fusion rates and clinical improvement, however, the anterior approach was associated with less morbidity in terms of blood loss, need for transfusion and hospital stay length.…”

Results of instrumented posterolateral fusion in treatment of lumbar spondylolisthesis with and without segmental kyphosis: A retrospective investigation

“…[41] In the study by Müslüman et al, the early clinical outcomes of higher fusion ratio and better clinical results were achieved by concomitant PLF and PLIF treatments. [39] Lei Cheng et al also documented better fusion rates and lower complication rates in the group of patients who underwent PLIF in combination with PLF; however, no significant statistical differences were observed. [34] Swan et al found significantly better outcomes with circumferential fusion at 6 months and 1 year postoperatively than the patients who received instrumented PLF; however, the results in the two study groups were similar 2 years after the treatment.…”

“…[34] However, the need for additional anterior column support for low-grade displacement is debatable since various clinical outcomes have been reported. [32,[34][35][36][37][38][39][40] Kim et al compared PLF, posterior lumbar interbody fusion (PLIF), and PLIF in combination with PLF in a recent prospective randomized study on degenerative lumbar diseases and concluded that there were no significant differences in the clinical results and union rates. [37] In a study by William et al as well, no consistent differences were noted in the clinical outcomes of groups treated with PLF and PLIF.…”