Comparison of Simple Lumbar Inter Body Fusion with Circumferential Fusion for Treatment of Isthmic Spondylolisthesis

Mohammad Abdul Mazid

doi:10.31031/cojnh.2018.02.000537

Abstract

Purpose: Spondylolisthesis is a common cause of surgery in patients with lower back pain. Although inter body fusion and circumferential fusion are a relatively common surgical method for the treatment of spondylolisthesis, we retrospectively compared surgical reduction or fusion in situ with simple lumbar inter body fusion (PLIF/TLIF) and circumferential fusion (PLF+TLIF/PLIF) for adult isthmic spondylolisthesis in terms of surgical invasiveness, clinical and radio graphical outcomes, and complications. Methods: From January 2013 to June 2015, 84 adult patients with isthmic spondylolisthesis who underwent surgical treatment in our department were randomized to simple lumbar inter body fusion (PLIF/TLIF) group (group 1, n=45) and circumferential fusion (PLF+TLIF/PLIF) group (group 2, n=39), and followed up for average 28.6 months (range 24-54 months). All patients of both groups had low back pain as their predominant symptom, with varying degree of radicular pain and neurological symptoms. The data collected retrospectively for analysis were: duration of symptoms, levels of fusion, revision surgery, clinical and radiographic results after surgery, and complications. Result: All the 84 patients compared in two surgical approaches for IS were included in this retrospective studies. In our analysis, for the surgical management of isthmic spondylolisthesis, we indicated that both approaches lumbar inter body fusion (PLIF/TLIF) and circumferential fusion (PLF+TLIF/PLIF) have equal significant, greater fusion rates with successful clinical outcomes

Highlights

BackgroundSpinal fusion technique was introduced 70 years ago for the treatment of degenerative disc disease and chronic lower back pain [1]
Our clinical experience along with statistic findings indicates that in conclusion, there was no significant difference was found between simple inter body fusion (PLIF/Transforaminal lumbar inter body fusion (TLIF)) compared to circumferential fusion (PLF+TLIF/posterior lumbar inter body fusion (PLIF))
Both techniques led to similar surgical outcomes and complication during follow-up. These results suggest that both procedures are effective for the treatment of isthmic spondylolisthesis

Summary

Introduction

Spinal fusion technique was introduced 70 years ago for the treatment of degenerative disc disease and chronic lower back pain [1]. Forward displacement of a vertebral bone in sequence of normal alignment of vertebra is called Isthmic Spondylolisthesis-most commonly due to progressive vertebral body malalignment in the lumbar region of spine. Even in severe case of spondylolisthesis, the slipped vertebra is comfortably reduced by the modern surgical techniques [4,5,6,7]. These operations have high risk of neurological complications from the implant and screws, even in correct procedure there are neurological complications [8]. In population after the forth decades 20.7% are affected [12], lumbosacral junction at lumber 5 and sacrum 1 (L5-S1) are mostly affected

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Discussion

Conclusion