Treatment of Adult Spondylolisthesis: PLIF versus PLF: Comparitive Study of Early Functional Outcome

Sakthivel Rn,Balakrishnan V

doi:10.4172/2471-8416.100036

Abstract

Objective: Aim of this study is to assess and compare the early functional outcomes and results of posterior lumbar interbody fusion (PLIF), and posterolateral fusion (PLF) in the surgical treatment of adult spondylolisthesis. Background: Posterolateral fusion has been considered the best method for surgical treatment of adult spondylolisthesis. This technique had been widely used. Superior results have subsequently been reported with interbody fusion with cages and posterior instrumentation. In axial loading pull out strength and eccentric loading remains a disadvantage for PLF. The problems such as axial pain, loss of reduction, loosening or failure of fixation materials occurred relatively frequently after posterolateral fusion could be improved by an operation that fused vertebral bodies. Materials and Methods: Fourty two patients with lumbar spondylolisthesis were operated with moderate to severe low back pain and/or sciatica. Patients with neurogenic claudication also were included. Randomisation technique was followed to allot patients into two different groups according to the mode of bony fusion into PLIF and PLF groups. Both groups were statistically identical. Results: PLIF and PLF groups had no major differences in blood loss, short-term postoperative clinical result, or complications. Surgical time was slightly prolonged in PLIF when compared to PLF. Visual analog scale for back pain and leg pain, the Oswestry disability index, and fusion rates were significantly better in PLIF. The lumbar lordosis and the segmental angle revealed greater improvement in the PLIF group. Conclusion: PLIF seems to be a better bone fusion technique than PLF in the management of lumbar spondylolisthesis. The problems encountered in PLF technique have been improved in PLIF.

Highlights

The primary objective in spondylolisthesis is to achieve a stable situation in terms of construct either with or without instrumentation along with adequate decompression
On average at the end of six months VAS score was assessed and showed improved leg pain from 72 mm preoperatively to 38 mm, whereas back pain improved from 64 mm preoperatively to 32 mm in the posterolateral fusion (PLF) group and the posterior lumbar interbody fusion (PLIF) leg pain from 76 mm to 40 mm and back pain 68 mm to 28 mm, but the difference between the two groups was not significant
At the end of final follow up VAS score in PLIF groups improved to 32 mm and slightly worsened to 44 mm in PLF group, whereas back pain improved in PLIF to 26 mm and increased to 40 mm in the PLF group; both the groups showed significant difference in terms of VAS for

Summary

Introduction

The primary objective in spondylolisthesis is to achieve a stable situation in terms of construct either with or without instrumentation along with adequate decompression. This would help the patients feel symptomatic relief. Cloward [4] was the first to fuse two adjacent vertebral bodies using bone grafts. He performed posterior laminectomy to decompress the cord. To date, both PLF and PLIF are widely used fusion techniques, applied during spondylolisthesis surgery [6,7,8]. There is a definitive indication to compare both the techniques which is the primary aim of our study

Materials and Methods

Functional Results

Radiological Results

Discussion