Posteriore und transforaminale lumbale interkorporelle Fusion (PLIF/TLIF) zur Therapie des lokalisierten Segmentaufbrauchs der LWS

Abstract

Chronic intractable low back pain is one of the most common orthopaedic diagnoses, with an enormous socioeconomic impact. The surgical treatment by posterior transpedicular instrumentation and interbody fusion of the affected segments is an established procedure after exhaustion of conservative therapies. Due to different study data on the clinical and functional results after posterior (PLIF) and transforaminal (TLIF) interbody fusion, our own patient population was analysed retrospectively. Included were 143 patients who had been treated surgically at our institution between 1999 and 2006 by one of the two methods (PLIF, n = 68; TLIF, n = 75). In addition to general demographic data, results of three questionnaires (Oswestry disability index, numeric rating scale, Roland Morris score) were retrospectively analysed before surgery and in the general follow-up - identifying clinical and functional results of patient satisfaction. All patients had been suffering in spite of the exhaustion of conservative therapies for at least six months of chronic low back pain prior to surgery. The mean age at surgery was 52 years. The complication rate was 23 %, the revision rate 15 %. Overall, there was a high patient satisfaction in follow-up. In ODI, a significant decrease in pain-related disability was observed from 49.8 % preoperatively to 24.7 % after surgery (p < 0.0001). This functional improvement was present in all aetiological subgroups irrespective of the fusion length. A statistically significantly better functional outcome was achieved in the ODI in the PLIF group (improvement 27.2 % vs. 23.1 %, p < 0.0001). The preoperative baseline regarding pain was assessed in the NRS on average at 6.5 points. Postoperatively, it decreased to 3.34 points (p < 0.0001). The functional limitation due to existing back pain was assessed preoperatively with an average of 13.08 points. Postoperatively a significant reduction to 6.19 points was observed (p < 0.0001). Group- or operation-specific differences were not statistically significant. The data of this study indicate that both TLIF and PLIF techniques are possible surgical treatment methods for patients with resistant chronic low back pain. With both techniques a clear benefit regarding quality of life and function for the operated patients is achievable, if the correct surgical indication is given.