Circumferential and Posterolateral Fusion for Lumbar Disc Disease

Abstract

Clinical outcome of low back fusion is unpredictable. There are various reports discussing the merits and clinical outcome of these two procedures. The patients were selected from a population of patients who had chronic low back pain unresponsive to conservative treatment. Thirty-six instrumented posterolateral fusions and 35 instrumented circumferential fusions with posterior lumbar interbody fusions were done simultaneously. Preoperative radiographic assessment included plain radiographs, magnetic resonance imaging scans, and provocative discography in all the patients. Posterolateral fusion or anterior lumbar interbody fusion was done for internal disc disruption. The Oswestry disability index, subjective scoring, and assessment of fusion were done at a minimum followup of 2 years. On subjective scoring assessment there was a satisfactory outcome of 63.9% (23 patients) in the posterolateral fusion group and 82.8% (29 patients) in the posterior lumbar interbody fusion group. On assessment by the Oswestry index no difference was found in outcome between the two groups. The posterolateral fusion group had a 63.9% satisfactory outcome and the posterior lumbar interbody fusion group had an 80% satisfactory outcome using the Oswestry disability index for postoperative assessment. There was 61.1% improvement in working ability in the posterolateral fusion group and 77.1% improvement in the posterior lumbar interbody fusion group which was not statistically significant. The authors consider instrumented circumferential fusion with posterior lumbar interbody fusion better than instrumented posterolateral fusion for managing chronic disabling low back pain.

Surgical Outcome and Postoperative Work Status of Lumbar Discogenic Pain Following Transforaminal Interbody Fusion

“…2) A comparison study found 61% improvement in working ability in the PLF group and 77% improvement in the PLIF group with statistical significance. 17) In this study, 33% in the PLF group and 46% in the PLIF group returned to original duties. Resumption rate of full time work after PLIF has been estimated as 34% in degenerative disc disease confirmed by discography, whereas overall resumption rate to work was 62%.…”

Perioperative Complications in Transforaminal Lumbar Interbody Fusion Versus Anterior–Posterior Reconstruction for Lumbar Disc Degeneration and Instability

“…[21][22][23] Fusion rates and clinical outcome evaluation were not the intention of this study. The immediate and short-term advantages of TLIF over AP surgery have been revealed by comparing operative data, hospitalization time, and complication rate.…”

The presacral retroperitoneal approach for axial lumbar interbody fusion

“…Pedicle screw and/or transfacet fixation to increase torsional stability is particularly useful in the presacral ALIF approach, as it provides posterior column stability across the fusion site, and added resistance to torsion. 32,33 The presacral ALIF approach may be associated with significant complications. 17,20 Perforation of the rectal wall can occur if the presacral space is developed inadequately.…”