Transforaminal lumbar interbody fusion versus instrumented posterolateral fusion in Grade I/II spondylolisthesis

Abstract

Background:Spondylolisthesis refers to slippage of one vertebra over the other, which may be caused by a variety of reasons such as degenerative, trauma, and isthmic. Surgical management forms the mainstay of treatment to prevent further slip and worsening. However, there is no consensus regarding the best surgical option to treat these patients. This study compares TLIF and instrumented PLF in patients with Grade I and II spondylolisthesis and analysis the outcome with respect to functional outcome, pain, fusion rate, adequacy of medial facetectomy for decompression, and complications.Materials and Methods:Forty patients operated for spondylolisthesis by instrumented posterolateral or transforaminal fusion between January 1, 2010, and June 30, 2012 were included in this retrospective study. They were followed up for 3 years. Twenty one cases were of instrumented posterolateral fusion (PLF) and 19 cases were of transforaminal lumbar interbody fusion (TLIF). The patients were asked to fill up the Oswestry disability index (ODI), Dallas Pain Questionnaire (DPQ), and low back pain rating scale (LBPRS) preoperatively, at 1-month postoperatively, and at 6, 12, 24, and 36 months postoperatively. Radiological parameters were assessed using radiographs.Results:No significant differences were found in DPQ, LBPRS, or ODI scores preoperative, 1-month postoperative, and at 6, 12, 24 and 36 months followup. No significant difference was found between the two groups in blood loss. The only significant difference between the two groups was in the operative time, in which the instrumented PLF group had a mean of 50 min lesser than the TLIF group (P = 0.02).Conclusions:TLIF and instrumented PLF are equally efficacious options in the treatment of Grade I and II spondylolisthesis, except lytic type.

Transforaminal Lumbar Interbody Fusion Versus Posterolateral Fusion Alone in the Treatment of Grade 1 Degenerative Spondylolisthesis

“…Various other studies have found no significant differences in complications and readmission rates between TLIF and PLF in heterogeneous populations of patients, 31 including a cohort of patients with grade 1 to 2 degenerative spondylolisthesis. 32 In 109 patients with spondylolisthesis, Glassman et al 33 found no difference in discharge disposition between the two approaches. Similarly, previous studies have found comparable RTW rates between TLIF and PLF.…”

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

“…The authors argued that a better radiologic union does not necessarily translate into a better clinical outcome when treating spondylolisthesis surgically. Similarly, Pooswamy et al [20] in a retrospective analysis, 40 patients with low-grade spondylolisthesis who had been monitored for 3 years were compared for surgical results between TLIF and instrumented PLF. Except for more operating time in the TLIF group, they discovered identical clinical and radiologic outcomes in both groups.…”

Postoperative Evaluation of Health-Related Quality-of-Life (HRQoL) of Patients With Lumbar Degenerative Spondylolisthesis After Instrumented Posterolateral Fusion (PLF): A prospective Study With a 2-Year Follow-Up

“…Nevertheless, the health-related outcomes are not significantly different between the two procedures [ 18 ]. Pooswamy et al conclude that TLIF and instrumented PLF are equally efficacious options in the treatment of Grade I and II spondylolisthesis, except lytic type [ 19 ].…”