Comparison of Clinical and Radiological Results of Posterolateral Fusion and Posterior Lumbar Interbody Fusion in the Treatment of L4 Degenerative Lumbar Spondylolisthesis

Kuraishi, Shugo; Takahashi, J.; Mukaiyama, Keijiro; Shimizu, Masayuki; Ikegami, Shota; Futatsugi, Toshimasa; Hirabayashi, Hiroki; Ogihara, Nobuhide; Hashidate, Hiroyuki; Tateiwa, Yutaka; Kinoshita, Hisatoshi; Kato, Hiroyuki

doi:10.4184/asj.2016.10.1.143

Cited by 22 publications

(27 citation statements)

References 30 publications

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“…Furthermore, spinal fusion may prevent recurrent stenosis. Some studies have reported the same fusion rate in PLF and PLIF groups (50). Similarly to the findings of most studies (50) who reported that fusion rate in the PLIF is more than PLF, we found higher fusion rates in patients who underwent PLIF rather than PLF with posterior instrumentation.…”

Section: Discussionsupporting

confidence: 88%

“…Similar to our findings, some authors have reported that the clinical results of PLIF are not superior than PLF in the treatment of lowgrade spondylolisthesis (14,41,48,58), although PLIF is expected to achieve better maintenance of correction and bony union. In addition, Kuraishi et al (50) reported that lumbar lordosis in the PLIF group was not better than that in the PLF group, which might be due to the lack of difference in clinical outcomes between the 2 groups.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2018

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Background: Degenerative lumbar spine disease can lead to lumbar spine instability. Lumbar spine instability is defined as an abnormal response to applied loads characterized kinematically by abnormal movement in the motion segment beyond normal constraints. Patients with lumbar spinal stenosis (LSS) typically present with low back pain (LBP), cramping, cauda equine syndrome, and signs of nerve root compression associated by weakness, numbness and tingling in their legs that are worsened with standing and walking. This degenerative condition severely restricts function, walking ability, and quality of life (QOL). Objectives: This study aims to compare clinical and radiological outcomes of posterolateral fusion (PLF) with posterior lumbar interbody fusion (PLIF) with posterior instrumentation in the treatment of LSS and degenerative instability. Study Design: A randomized, prospective, controlled clinical study. Methods: In this prospective study, 88 patients with LSS and degenerative instability were randomly allocated to one of 2 groups: PLF (Group I) or PLIF (Group II). Primary outcomes were the control of LBP and radicular pain, evaluated with visual analog scale (VAS), the improvement of QOL assessed by the Oswestry disability index (ODI) scale, and measurement of fusion rate, Cobb angle, spinal sagittal balance, and modic changes in the 2 groups. Results: At 24 months postoperatively, the mean reduction in VAS scores in Group I was more than in Group II (5.67 vs. 5.48, respectively) and the patients in Group I had more improvement in the ODI score than the patients in Group II (42.75 vs. 40.94, respectively). There was a statistically significant difference between the preoperative and postoperative sagittal balance in the 2 groups. The mean Cobb angle changed significantly in the 2 groups. Limitations: There are few prospective studies of PLIF or PLF in patients with LSS and degenerative lumbar spine instability, and a limited number of studies which exists have examined the safety and outcome of each procedure without comparing it with other fusion techniques. Because most of the studies in the literature have been conducted in the patients with IS, we could not compare and contrast our findings with studies in patients with LSS and degenerative lumbar spine instability. In addition, although in our study the findings at a 24-month follow-up period showed that PLF was better than PLIF in these patients, there were some studies in which the authors reported that PLIF showed better clinical results than PLF at a 48-month followup period. So we suggest that rigorous controlled trials at longer follow-up periods should be undertaken in groups of patients with LSS and degenerative lumbar spine instability who undergo posterior decompression and instrumented fusion to help to determine the ultimate best fusion technique for these patients. Conclusion: PLF with posterior instrumentation provides better clinical outcomes and improvement in the LBP, radicular pain, and functional QOL, more correction of the Cobb angle, more restoration of sagittal alignment, more decrease in Modic type 1, and more increase in Modic type 0, despite the low fusion rate compared to PLIF. Key words: Lumbar spinal stenosis, degenerative instability, posterolateral fusion, posterior lumbar interbody fusion, low back pain, quality of life, cobb angle, fusion rate, mobic changes, sagittal balance

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 97%

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

et al. 2018

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“…Although lumbar interbody fusion techniques might yields higher fusion rates, still the clinical outcome with PLF is not compromised. 2,21,32 In the studied patients, the reduction of the mean VAS for back pain after six months postoperatively was 5.9±0.2. This is comparable to similar improvement in other instrumented PLF or PLIF/ TLIF/ALIF series, 3,2,4,32 with mean VAS reduction of 4.8±1.2, 5.2±1.1, 3.6±0.9, and 4.4±1.2 respectively.…”

Section: Discussionmentioning

confidence: 84%

Instrumented Posterolateral Spinal Arthrodesis as an Effective Treatment for Single Level Symptomatic Vacuum Lumbar Disc Degeneration in Elderly Patients

Hamouda

2017

Egyptian Spine Journal

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Background Data: Lumbar intervertebral disc vacuum phenomenon is an advanced form of spinal destabilizing degenerative changes. It is common in the elderly population and can cause refractory low back pain. Purpose: To evaluate the efficacy and safety of instrumented posterolateral fusion in treating symptomatic lumbar single level vacuum phenomenon in elderly population. Study Design: Retrospective descriptive clinical case series. Patients and Methods: Twenty-one patients (16 males & 5 females), aging more than 65 years, had all their files reviewed. They were operated by instrumented posterolateral fusion to treat chronic refractory low back pain due to single level intervertebral lumbar disc vacuum phenomenon. They underwent operation after failure of adequate 6 months conservative management. Age, gender, symptoms duration, spinal level affected, surgery duration, length of hospital stay, intra or post-operative complications, visual analogue scale VAS for pain, and Lenke's graft fusion classification at 1, 3 & 6 months postoperatively were all recorded. Results: The results of this study showed the most affected level was L4/L5, mean age was 73±7 years, mean symptoms duration was 11 years, mean surgery duration was 137±29 minutes, and mean VAS for preoperative-postoperative pain improvement was 5.9±1.2. Good fusion (Lenke's grades A & B) was reported in 81% of patients. No major intra or postoperative complications. Conclusion: Instrumented posterolateral fusion in elderly population patients with monosegmental advanced disc degeneration may yield clinical outcome with low operative risk. (2017ESJ150)

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“…However, operative time and EBL were greater in the PLF population. Two additional smaller recent retrospective studies also demonstrate no difference in clinical outcomes at long-term follow-up between PLF and either TLIF or PLIF [34,35].…”

Section: Interbody Fusionmentioning

confidence: 91%

Treatment for Degenerative Lumbar Spondylolisthesis: Current Concepts and New Evidence

Samuel

Moore

Cunningham

2017

Curr Rev Musculoskelet Med

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There is some moderate evidence that decompression alone may be a feasible treatment with lower surgical morbidity and similar outcomes to fusion when performed in a select population with a low-grade slip. Similarly, addition of interbody fusion may be best suited to a subset of patients with high-grade degenerative spondylolisthesis, although this remains controversial. Minimally invasive techniques are increasingly being utilized for both decompression and fusion surgeries with more and more studies showing similar outcomes and lower postoperative morbidity for patients. This will likely be an area of continued intense research. Finally, the role of spondylolisthesis reduction will likely be determined as further investigation into optimal sagittal balance and spinopelvic parameters is conducted. Future identification of ideal thresholds for sagittal vertical axis and slip angle that will prevent progression and reoperation will play an important role in surgical treatment planning. Current evidence supports surgical treatment of degenerative spondylolisthesis. While posterolateral spinal fusion remains the treatment of choice, the use of interbodies and decompressions without fusion may be efficacious in certain populations. However, additional high-quality evidence is needed, especially in newer areas of practice such as minimally invasive techniques and sagittal balance correction.

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Comparison of Clinical and Radiological Results of Posterolateral Fusion and Posterior Lumbar Interbody Fusion in the Treatment of L4 Degenerative Lumbar Spondylolisthesis

Cited by 22 publications

References 30 publications

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

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

Instrumented Posterolateral Spinal Arthrodesis as an Effective Treatment for Single Level Symptomatic Vacuum Lumbar Disc Degeneration in Elderly Patients

Treatment for Degenerative Lumbar Spondylolisthesis: Current Concepts and New Evidence

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