Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Study Design: Systematic review and meta-analysis. Objectives: Arthrodesis has been a valid treatment option for spinal diseases, including spondylolisthesis and lumbar spinal stenosis. Posterolateral and posterior lumbar interbody fusion are amongst the most used fusion techniques. Previous reports comparing both methods have been contradictory. Thus, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to establish substantial evidence on which fusion method would achieve better outcomes. Methods: Major databases including PubMed, Embase, Web of Science and CENTRAL were searched to identify studies comparing outcomes of interest between posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF). We extracted data on clinical outcome, complication rate, revision rate, fusion rate, operation time, and blood loss. We calculated the mean differences (MDs) for continuous data with 95% confidence intervals (CIs) for each outcome and the odds ratio with 95% confidence intervals (CIs) for binary outcomes. P < 0.05 was considered significant. Results: We retrieved 8 studies meeting our inclusion criteria, with a total of 616 patients (308 PLF, 308 PLIF). The results of our analysis revealed that patients who underwent PLIF had significantly higher fusion rates. No statistically significant difference was identified in terms of clinical outcomes, complication rates, revision rates, operation time or blood loss. Conclusions: This systematic review and meta-analysis provide a comparison between PLF and PLIF based on RCTs. Although PLIF had higher fusion rates, both fusion methods achieve similar clinical outcomes with equal complication rate, revision rate, operation time and blood loss at 1-year minimum follow-up.

Beneficial influence of single-stage posterior surgery for the treatment of lumbar brucella spondylitis combined with spondylolisthesis

“…Therefore, internal fixation instruments are conducive to bone graft fusion. Said et al 33 researched that the patients with lumbar spondylolisthesis combined with an isthmus, posterior interbody fusion might restore spinal stability, improve bone graft fusion, and have an excellent long-term clinical effect. In this study, 62.6% of patients were complicated with an isthmus.…”

Safety and Efficacy of Cortical Bone Trajectory Screw Fixation Combined with Facet Fusion for the Treatment of Lumbar Degenerative Disease

“…Posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) are currently the most clinically used lumbar fusion method 5 . However, PLIF is more invasive, and it is inevitable to retract the dural sac and nerve root during the operation, so the risk of nerve injury is high 6,7 . Although TLIF has the advantage of less invasion, it has high requirements for operation techniques, more intraoperative blood loss, and a high incidence of postoperative complications 8,9 .…”

“…5 However, PLIF is more invasive, and it is inevitable to retract the dural sac and nerve root during the operation, so the risk of nerve injury is high. 6,7 Although TLIF has the advantage of less invasion, it has high requirements for operation techniques, more intraoperative blood loss, and a high incidence of postoperative complications. 8,9 Mainstream lumbar fusion techniques have different shortcomings, spine surgeons have been seeking less invasive methods of achieving complete decompression with satisfactory fusion rates.…”

Emergency treatment for iatrogenic lumbar arterial injury occurred during posterior lumbar interbody fusion: a case report

“…Lumbar fusion is an effective treatment for various degenerative diseases [1]. Posterior lumbar interbody fusion (PLIF) provides safe stabilization of the anterior column and enables posterior decompression without necessitating an anterior approach [2]. However, PLIF is a technically challenging procedure, and like other lumbar fusion techniques, it carries the risk of complications [2,3].…”

“…Posterior lumbar interbody fusion (PLIF) provides safe stabilization of the anterior column and enables posterior decompression without necessitating an anterior approach [2]. However, PLIF is a technically challenging procedure, and like other lumbar fusion techniques, it carries the risk of complications [2,3]. Specifically, vascular injuries, though rare (0.01-0.22%), should not be overlooked, as delayed diagnosis can result in severe consequences such as massive hemorrhage and life-threatening shock [4,5].…”