Comparison of PLIF/TLIF and LLIF for two-level degenerative lumbar spondylolisthesis

Abstract

IntroductionIn recent years, lateral lumbar interbody fusion (LLIF), performed as extreme lateral interbody fusion (XLIF) and oblique lateral interbody fusion (OLIF), has also become widely used for anterior-posterior corrective fusion. However, there are few detailed reports comparing techniques in the treatment of two-level degenerative spondylolisthesis. We compared the surgical invasiveness and postoperative outcomes between posterior interbody fusion with posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) and LLIF for two-level lumbar degenerative spondylolisthesis. MethodsFifteen patients underwent PLIF or TLIF at 2 vertebral intervals (posterior group) and 8 patients received XLIF or OLIF (LLIF group). The following parameters were examined: operative time, blood loss, preoperative %slip, preoperative sagittal parameters, postoperative %slip, postoperative 1-year %slip, postoperative 1-year sagittal parameters, bone fusion rate at 1 year postoperatively, pre- and postoperative visual analog scale scores, pre- and postoperative Japanese Orthopaedic Association (JOA) scores, and complications. ResultsIn the LLIF group, blood loss was significantly lower and operative time was shorter than in the posterior group. There were no significant differences for 1-year postoperative %slip, sagittal vertical axis, or lumbar lordosis, although the frequency of cases with a 1-year postoperative pelvic incidence (PI)-LL ≤ 10 degrees was significantly higher in the LLIF group. In both groups, JOA scores were improved significantly at 1 year postoperatively (both p < 0.01), with no remarkable difference in improvement rate between the groups (p = 0.09). ConclusionsLLIF was less invasive, comparably effective, and more preserving of global spinal balance in correcting two-level degenerative spondylolisthesis than conventional posterior interbody fusion.