Prospective Study of Posterior Lumbar Interbody Fusion and Posterolateral Fusion for Degenerative Spondylolisthesis.
J Spinal Disord Tech. 2013 Jul 8;
Authors: Sivaraman A, Altaf F, Jalgoankar A, Kakkar R, Sirigiri PB, Howieson A, Crawford PJ
STUDY DESIGN:: A prospective study of two different fusion techniques for the treatment of single level degenerative spondylolisthesis.
OBJECTIVE:: To determine whether the addition of an intervertebral cage improves the clinical outcome and fusion rate of patients undergoing posterior lumbar interbody fusion after decompression for degenerative spondylolisthesis.
SUMMARY OF BACKGROUND DATA:: The surgical approach that should be used for degenerative spondylolisthesis is a controversial issue. Decompression and posterior lumbar interbody fusion (PLIF) with an interbody cage is widely used. Theoretical advantages in favour of PLIF include anterior column support, indirect foraminal decompression, restoration of lordosis, and reduction of the slip via ligamentotaxis. Despite numerous publications, the scientific support for the PLIF method is, however weak.
METHODS:: A prospective study was carried out including 59 patients with degenerative spondylolisthesis. Average age of patients was 66 years: 34 males and 25 females. Patients were divided into two treatment groups: Group1-32 patients with PLIF with interbody graft and Group 2-27 patients with PLIF with cage. Minimum two years follow-up. Outcomes were assessed by measuring pre- and post-operative lordotic angles. SF-12 physical and mental health scores were recorded along with visual analogue scores for pain. Complications were also recorded.
RESULTS:: No significant difference in the post-operative lordotic angles achieved between the two techniques. Non-significant difference in the clinical outcomes between both techniques.
CONCLUSION:: We have found the use of a cage to achieve lumbar interbody fusion in the treatment of degenerative lumbar spondylolisthesis does not confer any significant advantages in terms of restoration of lumbar lordosis, improvement in clinical symptoms, or relief of pain post-operatively.
PMID: 23839022 [PubMed – as supplied by publisher]