Comparison of Simple Lumbar Interbody Fusion with CircumferentialFusion for Treatment of Isthmic Spondylolisthesis

Abstract

Purpose: Spondylolisthesis is a common cause of surgery in patients with lower back pain. Although interbody fusion and circumferential fusion are a relatively common surgical method for the treatment of spondylolisthesis, we retrospectively compared surgical reduction or fusion in situ with simple lumbar interbody fusion (PLIF/TLIF) and circumferential fusion (PLF+TLIF/PLIF) for adult isthmic spondylolisthesis in terms of surgical invasiveness, clinical and radiographical outcomes, and complications.Methods: From January 2013 to June 2015, 84 adult patients with isthmic spondylolisthesis who underwent surgical treatment in our department were randomized to simple lumbar interbody fusion (PLIF/TLIF) group (group 1, n=45) and circumferential fusion (PLF+TLIF/PLIF) group (group 2, n=39), and followed up for average 28.6 months (range 24-54 months). All patients of both groups had low back pain as their predominant symptom, with varying degree of radicular pain and neurological symptoms. The data collected retrospectively for analysis were: duration of symptoms, levels of fusion, revision surgery, clinical and radiographic results after surgery, and complications. Results:All the 84 patients compared in two surgical approaches for IS were included in this retrospective studies. In our analysis, for the surgical management of isthmic spondylolisthesis, we indicated that both approaches lumbar interbody fusion (PLIF/TLIF) and circumferential fusion (PLF+TLIF/PLIF) have equal significant, greater fusion rates with successful clinical outcomes. Conclusion:Our clinical experience along with statistic findings indicates that in conclusion, there was no significant difference was found between simple interbody fusion (PLIF/TLIF) compared to circumferential fusion (PLF+TLIF/PLIF). Moreover, both techniques led to similar surgical outcomes and complication during follow-up. Thus, these results suggest that both procedures are equally effective for the treatment of isthmic spondylolisthesis. Keywords: Introduction BackgroundSpinal fusion technique was introduced 70 years ago for the treatment of degenerative disc disease and chronic lower back pain [1]. Hibbs and Albee were two spine surgeons in 1911, who performed first spinal stabilization surgery [2,3]. Forward displacement of a vertebral bone in sequence of normal alignment of vertebra is called Isthmic Spondylolisthesis-most commonly due to progressive vertebral body malalignment in the lumbar region of spine. Even in severe case of spondylolisthesis, the slipped vertebra is comfortably reduced by the modern surgical techniques [4][5][6][7].However, these operations have high risk of neurological complications from the implant and screws, even in correct procedure, there areneurological complications [8]. There are no significant neurological complication differences found between the reduction procedure and fusion situ [5,[8][9][10]. About 90% of all vertebral body slips due to the degenerative and isthmic types of spondylolisthesis [11]. Generally in populati...

Comparative Study of Transpedicular Fixation with and without Interbody Fusion Cage in Management of L4-L5 Lumbar Degenerative Spondylolisthesis

“…To remove a herniated disc or a portion of one that is positioned between two neighboring vertebrae in the lumbar spine, a procedure known as anterior lumbar interbody fusion, or ALIF, is performed on the spine [3] . The formation of a solid arthrodesis over a spinal motion segment is one of the objectives of anterior lumbar inter-body fusion.…”

Comparative Study on the Effectiveness of Posterolateral Fusion vs. Interbody Fusion in Isthmic/Degenerative Spondylolisthesis

“…12 According to a report the clinical success rate of posterolateral fusion is about 81 -100%. 13 The use of TLIF (transforaminal lumbar interbody fusion) in addition to standard posterolateral spinal fusion for the treatment of spondylolisthesis continues to be another option. 14 The principal indication of surgery in TLIF is the stabilization and fusion of the spine following the correction of adult spinal deformity.…”