Fueling the debate: Are outcomes better after posterior lumbar interbody fusion (PLIF) or after posterolateral fusion (PLF) in adult patients with low-grade adult isthmic spondylolisthesis?

Abstract

Study design: Retrospective cohort study.Clinical question: Do more adult patients affected by low grade isthmic spondylolisthesis have significant clinical and radiological improvement following posterior lumbar interbody fusion (PLIF) than those who receive posterolateral fusion (PLF)?Methods: One hundred and fourteen patients affected by adult low grade isthmic spondylolisthesis, treated with posterior lumbar interbody fusion or posterolateral fusion, were reviewed. Clinical outcome was assessed by means of the questionnaires ODI, RMDQ and VAS. Radiographic evaluation included CT, MRI, and x-rays. The results were analyzed using the Student t-test.Results: The two groups were similar with respect to demographic and surgical characteristics. At an average follow-up of 62.1 months, 71 patients were completely reviewed. Mean ODI, RMDQ and VAS scores didn't show statistically significant differences. Fusion rate was similar between the two groups (97% in PLIF group, 95% in PLF group). Major complications occurred in 5 of 71 patients reviewed (7%): one in the PLIF group (3.6%), four in the PLF group (9.3%). Pseudarthrosis occurred in one case in the PLIF group (3,6%) and in two cases in PLF group (4.6%).Conclusions: In our series, there does not appear to be a clear advantage of posterior lumbar interbody fusion (PLIF) over posterolateral fusion (PLF) in terms of clinical and radiological outcome for treatment of adult low grade isthmic spondylolisthesis.

Posterior lumbar interbody fusion and posterolateral fusion: Analogous procedures in decreasing the index of disability in patients with spondylolisthesis

“…They assessed clinical outcome and to define it, what they used was ODI, Roland Morris Disability Questionnaire, visual analog scale (leg score and back score), persistent low back pain and persistent sciatica. [ 21 ] Unlike our study, they did not assess the disability of patients separately.…”

Comparison of Posterolateral Lumbar Fusion and Posterior Lumbar Interbody Fusion for Patients Younger Than 60 Years With Isthmic Spondylolisthesis

“…[1][2][3][4][5][6][7][8][9][10] Many studies have compared the clinicoradiological outcomes of PLIF and PLF. Conservative treatment often fails to provide relief, so surgical treatment, such as segmental lumbar fusion with an anterior or posterior approach, is required for many patients.…”

PLF Versus PLIF and the Fate of L5-S1

“…There was wide variation in followup times including a RCT by Farrokhi et al 22 having followup of 1 year. Although Barbanti et al, 12 had an average follow-up of 62.1 months, 38% of the 71 patients in the study were lost to follow-up. Luo et al, 27 criticized their own meta-analysis paper and commented that ''it did not provide high-quality evidence for their conclusions and that more well-designed RCTs were necessary to provide stronger evidence.''…”

“…This lack of consensus is multifactorial. First, there were small sample sizes (<50) in several of these studies 9,12,14,17,21,22,23 which increased heterogeneity and bias and contributed to errors in interpretation of the data. There was wide variation in followup times including a RCT by Farrokhi et al 22 having followup of 1 year.…”

“…Comparative studies between PLF and PLIF have been well documented in the literature but with wide variations in their conclusions. Most of the articles are a mix of comparative observational studies (COS), 4–17 randomized control studies (RCTs), 18–23 or meta-analysis based on combination of RCTs and observational studies 24–29 . Comparison has been mainly based on clinical outcome measures and radiographic fusion rates.…”