Posterior lumbar interbody fusion (PLIF) Versus Inter-transverse Posterolateral Fusion (PLF) for Treatment of Lumbar Spondylolisthesis: a Comparative Study

Abstract

Background Data: Lumbar spondylolisthesis is a common condition. Indications for surgery other than failure of conservative treatment include progressive neurological deficits, intractable and symptomatic spinal instability. Surgical options include posterior interbody fusion and posterolateral fusion.Purpose: To compare the difference in results between lateral inter-transverse fusion (PLF) alone and posterior lumbar interbody fusion (PLIF) regarding clinical outcome and fusion rate. Study Design: This is a retrospective randomized comparative study. Patients and Methods: Between May 2009 and April 2014 there were 132 patients with various degrees of lumbar spondylolisthesis. Fifty eight (43.9 %) patients were treated by pedicle screws and PLIF and 74 (56.1%) patients treated with pedicle screws and inter-transverse fusion. This study included 87 female patients (65.9 %) and 45 male patients (34.1 %) with average age 52.2 (age ranged from 43-62). There were 69 patients (52.2 %) had one segment fusion and 63 cases (47.8 %) had 2 segments fusion. All patients were evaluated clinically by Japanese Orthopedic Association Score (JOAS) for preoperative and postoperative and follow-up evaluation. Radiologicalassessment using plain X-ray and MRI was performed for assessment before and after the procedure. Flexion and extension plain X-ray films were obtained and depended upon for confirmation of fusion/stability. The mean follow up period was 18 months. Results: There was significant improvement in the final outcome of both groups as there mean improvement rate (IR) for Group A was 89.08±%10.6 (ranged from 60-100 %). However Group B at the final outcome had a mean IR of 81.813.8%± ranged from (45-100). Fusion rate was 82% for group A compared to 89% for group B. Patients satisfaction was 89% for Group A while in Group B 94% of patients were satisfied.Conclusion: There were no significant differences in results between lateral intertransverse fusion and PLIF regarding clinical outcome or fusion rate. Cost effectiveness may be considered as an important factor for decision making in treatment of degenerative spondylolisthesis. (2013ESJ063)