Posterior Lumbar Interbody Fusion and Instrumented Posterolateral Fusion in Adult Spondylolisthesis: Assessment and Clinical Outcome

Abstract

Aim of this study is to assess and compare the outcomes of posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) in adult isthmic spondylosthesis. BACKGROUND: Posterolateral fusion has been considered the best method and widely been used for surgical treatment of adult spondylolisthesis.Superior results have subsequently been reported with interbody fusion with cages and posterior instrumentation MATERIALS AND METHODS: Thirty six patients with isthmic spondylolisthesis were operated. One group (20 patients) had decompression and posterolateral fusion (PLF) with a pedicle screw system; other group (16 patients) was treated by decompression, posterior lumbar interbody fusion (PLIF) and a Pedicle screw system. In both groups adequate decompression was done RESULTS: Seventy seven percent of the patients had a good result with (PLIF) and 68 percent with posterolateral fusion (PLF). However there was no statistical difference in cases with low grade slipping, whereas the difference was significant for cases with high grade slipping. Fusion rate was 93% with (PLIF) and 68% with (PLF), but without any significant incidence in the functional outcome. 78% has relief of sciatica and neurogenic claudication. CONCLUSION: Based on these findings we found that for high grade spondylolisthesis which requires reduction or if the disc space is still high posterior lumbar inter body fusion is preferable. For low grade spondylolisthesis or if the disc space is narrow posterolateral fusion is preferable. A successful result of fusion operation depends on adequate decompression which relieves radicular symptoms.

PLF Versus PLIF and the Fate of L5-S1

“…Along with Kim et al , 19 RCTs (we discussed before), another prospective randomized study in 2014 by Lee et al 23 in patients aged 60 or younger with isthmic spondylolisthesis, found at 2 years after surgery radiographic nonunions of 10.3% in the PLF group and 9.6% in the PLIF group ( P = 0.93). Chen et al 28 performed a meta-analysis with three RCTs 20–22 and four comparative studies, 9,12,16 with 239 pooled PLF patients and 224 PLIF patients. Their meta-analysis indicated that the fusion rates were found to be similar for the two techniques (Risk Ratio = 1.07, 95% CI: 0.95–1.21, P = 0.25; P for heterogeneity = 0.01, I 2 = 63%).…”

“…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.…”