A comparative study of functional outcome between posterior lumbar fusion and posterior lumbar interbody fusion in spondylolisthesis
Keywords:Spondylolisthesis, Posterior lumbar fusion, Posterior lumbar interbody fusion
Background: Spondylolisthesis is condition in which one vertebra slips over other vertebra. This study has been done to compare the functional outcome and complications of two techniques: posterior lumbar fusion (intertransverse fusion) and posterior lumbar interbody fusion.
Methods: Total 20 patients with spondylolisthesis admitted in a tertiary care centre in Rajasthan were allotted alternatively in posterior lumbar fusion (PLF) group and posterior lumbar interbody fusion (PLIF) group. In PLF, fusion was done by placing bone graft between transverse processes and around facets. In PLIF, fusion was bone by placing cage in between vertebral bodies.
Results: 20 patients were included in our study with female predominance (65%). Mean age was 54.2 years (PLF=58.4 and PLIF=50.2). 70% patients have L4-L5 level spondylolisthesis. Average operative time was less in PLF group, which is statistically significant. Functional outcome was measured by using visual analogue scale (VAS) score and Japanese orthopedics association score (JOAS) at 3 weeks, 3 months and 6 months. There is a significant decrease between preoperative VAS and at 6 months, in both PLF and PLIF group. JOAS was significantly increased at 6 months in both PLF and PLIF group as compared to preoperative score. But difference in JOAS at 6 months is not significant between PLF and PLIF.
Conclusions: Both PLF and PLIF are equally effective for spondylolisthesis. Both techniques have same satisfactory results. As PLIF is more invasive technique, more operative time and more complications are seen.
O'Donnell JB. A biomechanical comparison of an interspinous fixation device and a pedicle screw and rod system for posterior fixation. Sem Schol. 2010.
Panjabi MM. Clinical spinal instability and low back pain. J Electromyograph Kinesiol. 2003;13(4):371-9.
Hensinger RN. Spondylolysis and spondylolisthesis in children and adolescents. JBJS. 1989;71(7):1098-107.
Laurent LE, Einola S. Spondylolisthesis in children and adolescents. Acta Orthopedicsa Scandinavica. 1961;31(1):45-64.
Scot Boden D,Riew Daniel,etal. Biomechanics of spondylolisthesis. J Bone Joint Surg. 1996:403-11.
Möller H, Hedlund R. Surgery versus conservative management in adult isthmic spondylolisthesis: a prospective randomized study: part 1. Spine. 2000;25(13):1711-5.
Cloward RB The treatment of ruptured intervertebral discs by vertebral body fusion: Indications, operative technique, after care. J neurosurgery. 1953;10(2):154-68.
Bogduk N. Clinical anatomy of the lumbar spine and sacrum. 5th ed. London: Churchill Livingstone; 2005.
Arslan M, Comert A, Acar HI, Ozdemir M, Elhan A, Tekdemir I, et al. Surgical view of the lumbar arteries and their branches: an anatomical study. Op Neurosurg. 2011;68(1):16-22.
Wiltse LL. Spondylolisthesis: classification and etiology: symposium of the spine. Am Acad Orthop Surg. 1969:143-5.
Louis R. Fusion of the lumbar and sacral spine by internal fixation with screw plates. Clinical Orthopedics and Related Research. 1986;203:18-33.
Edeinken. Spondylolisthesis in children and adolescents. Bone Joint Surg. 1981;63(1):67-70.
Koslosky E, Gendelberg D. Classification in brief: the Meyerding classification system of spondylolisthesis. Assoc Bone Joint Surg. 2020;478(5):1125-30.
Belfi LM, Ortiz AO, Katz DS. Computed tomography evaluation of spondylolysis and spondylolisthesis in asymptomatic patients. Spine. 2006;31(24):907-10.
Laasonen EM, Ehrström J. Myelography in lumbar spondylolisthesis. Acta Radiological Diagnosis. 1978;19(6):889-96.
Roca J, Ubierna MT, Cáceres E, Iborra M. One-stage decompression and posterolateral and interbody fusion for severe spondylolisthesis: an analysis of 14 patients. Spine. 1999;24(7):709-14.
Boxall D, Bradford DS, Winter RB, Moe JH. Management of severe spondylolisthesis in children and adolescents. J Bone Joint Surg. 1979;61(4):479-95.
Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. European Spine Journal. 2008;17(3):327-35.
Polly DW. Epidural steroids for degenerative spondylolisthesis: good, bad, or indifferent? Commentary on an article by Gerling MC, MD, et al.: epidural steroid injections for management of degenerative spondylolisthesis. little effect on clinical outcomes in operatively and nonoperatively treated patients”. J Bone Joint Surg. 2020;102(15):1378.