Which lumbar interbody fusion technique is better in terms of level for the treatment of unstable isthmic spondylolisthesis?

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The purpose of this study was to investigate and compare clinical and radiographic outcomes of 2 kinds of lumbar interbody fusion (LIF) for the treatment of adult low-grade isthmic spondylolisthesis at L4–5 and L5–S1 levels.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The medical records and radiographs of 86 patients who underwent anterior LIF (ALIF) (L4–5, 42 patients; L5–S1, 44 patients) and 42 patients who underwent transforaminal LIF (TLIF) (L4–5, 22 patients; L5–S1, 20 patients) between 2001 and 2004 were retrospectively reviewed. Clinical results were investigated using the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, and using radiographic measurements, including disc height (DH), degree of spondylolisthesis, segmental lordosis, whole lumbar lordosis (WL), sacral slope (SS), and pelvic tilt; the L-1 axis S-1 distance (LASD) and pelvic incidence were also obtained.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In both groups, VAS and ODI scores had significantly improved at both treatment levels. Statistical analysis showed no significant difference in postoperative VAS scores between groups at the L4–5 level and in postoperative VAS/ODI scores at the L5–S1 level. However, ODI scores were better in the TLIF than in the ALIF group at the L4–5 level. In terms of radiological changes, there were no significant differences between the 2 groups at the L4–5 level; however, at the L5–S1 level, radiographic results indicated that ALIF was superior to TLIF in its capacity to restore DH, WL, SS, and LASD. The radiological evidence of fusion shows no intergroup difference and no interlevel difference.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Considering the clinical and radiological outcomes in both groups, the authors recommend that instrumented mini-TLIF is preferable at the L4–5 level, whereas instrumented mini-ALIF might be preferable at the L5–S1 level for the treatment of unstable isthmic spondylolisthesis.</jats:p></jats:sec>

Radiographic Comparison of Lateral Lumbar Interbody Fusion Versus Traditional Fusion Approaches: Analysis of Sagittal Contour Change

“…22,23 As with previous studies, our results also show that disc height restoration, both anterior and posterior, is better achieved with interbody cage placement, as LLIF, ALIF and TLIF all yielded significant improvements post-operatively, whereas PSF did not. [24][25][26] In fact the post-operative posterior disc height in PSF decreased significantly compared to baseline. Bilateral pedicle screws were used to augment all the PSF procedures.…”

Mini-open lateral retroperitoneal lumbar spine approach using psoas muscle retraction technique. Technical report and initial results on six patients

“…Guerin et al [3] performed an anatomical study on the safe working zones inside the psoas muscle and found that at L3-4 and L4-5 levels, the ''safest'' zone is always posterior to genitofemoral nerve. Anterior lumbar interbody fusion is another alternative to XLIF [8][9][10][11][12][13][14][15][16][17][18][19]. However, there are several limitations associated with this ALIF.…”

Changes in the Adjacent Segment 10 Years After Anterior Lumbar Interbody Fusion for Low-Grade Isthmic Spondylolisthesis

“…interbody fusion can support the anterior column, reduce slippage, minimize posterior injury, and restore disc height to achieve indirect neural decompression [4,5,15,16,22].…”