Posterolateral instrumented fusion with and without transforaminal lumbar interbody fusion for the treatment of adult isthmic spondylolisthesis: A randomized clinical trial with 2-year follow-up

Mohammad Reza Etemadifar, Abdollah Hadi, Mehran Feizi Masouleh, Mohammad Reza Etemadifar, Abdollah Hadi, Mehran Feizi Masouleh

Abstract

Background: Spondylolisthesis is a common cause of surgery in patients with lower back pain. Although posterolateral fusion and pedicle screw fixation are a relatively common treatment method for the treatment of spondylolisthesis, controversy exists about the necessity of adding interbody fusion to posterolateral fusion. The aim of our study was to assess the functional disability, pain, and complications in patients with spondylolisthesis treated by posterolateral instrumented fusion (PLF) with and without transforaminal lumbar interbody fusion (TLIF) in a randomized clinical trial.

Materials and methods: From February 2007 to February 2011, 50 adult patients with spondylolisthesis were randomly assigned to be treated with PLF or PLF+TLIF techniques (25 patients in each group) by a single surgeon. Back pain, leg pain, and disability were assessed before treatment and until 2 years after surgical treatment using visual analog scale (VAS) and oswestry disability index (ODI). Patients were also evaluated for postoperative complications such as infection, neurological complications, and instrument failure.

Results: All patients completed the 24 months of follow-up. Twenty patients were females and 30 were males. Average age of the patients was 53 ± 11 years for the PLF group and 51 ± 13 for the PLF + TLIF group. Back pain, leg pain, and disability score were significantly improved postoperatively compared to preoperative scores (P < 0.001). At 3 months of follow-up, there was no statistically significant difference in VAS score for back pain and leg pain in both groups; however, after 6 months and 1 year and 2 years follow-up, the reported scores for back pain and leg pain were significantly lower in the PLF+TLIF group (P < 0.05). The ODI score was also significantly lower in the PLF+TLIF group at 1 year and 2 years of follow-up (P < 0.05). One screw breakage and one superficial infection occurred in the PLF+TLIF group, which had no statistical significance (P = 0.373).

Conclusion: It seems that accompanying TLIF with PLF might lead to better functional improvement and pain reduction in patients with spondylolisthesis.

Keywords: Posterolateral instrumented fusion (PLF); spine; spondylolisthesis; transforaminal lumbar interbody fusion (TLIF).

Figures

Figure 1
Figure 1
Mean Vas score for back (a) and leg (b) at the baseline and follow-up visits in patients treated with PLF and PLF + TLIF procedures
Figure 2
Figure 2
Mean ODI at the baseline and follow-up visits in patients treated with PLF and PLF + TLIF procedures

References

    1. Taillard WF. Etiology of spondylolisthesis. Clin Orthop Relat Res. 1976;117:30–9.
    1. Kalichman L, Kim DH, Li L, Guermazi A, Berkin V, Hunter DJ. Spondylolysis and spondylolisthesis: Prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976) 2009;34:199–205.
    1. Osterman K, Schlenzka D, Poussa M, Seitsalo S, Virta L. Isthmic spondylolisthesis in symptomatic and asymptomatic subjects, epidemiology, and natural history with special reference to disk abnormality and mode of treatment. Clin Orthop Relat Res. 1993:65–70.
    1. McTimoney CA, Micheli LJ. Current evaluation and management of spondylolysis and spondylolisthesis. Curr Sports Med Rep. 2003;2:41–6.
    1. Stewart TD. The age incidence of neural-arch defects in Alaskan natives, considered from the standpoint of etiology. J Bone Joint Surg Am. 1953;35-A:937–50.
    1. Jacobs WC, Vreeling A, De Kleuver M. Fusion for low-grade adult isthmic spondylolisthesis: A systematic review of the literature. Eur Spine J. 2006;15:391–402.
    1. Gill GG, Manning JG, White HL. Surgical treatment of spondylolisthesis without spine fusion; excision of the loose lamina with decompression of the nerve roots. J Bone Joint Surg Am. 1955;37-A:493–520.
    1. Moller H, Hedlund R. Instrumented and noninstrumented posterolateral fusion in adult spondylolisthesis — A prospective randomized study: Part 2. Spine (Phila Pa 1976) 2000;25:1716–21.
    1. France JC, Yaszemski MJ, Lauerman WC, Cain JE, Glover JM, Lawson KJ, et al. A randomized prospective study of posterolateral lumbar fusion. Outcomes with and without pedicle screw instrumentation. Spine (Phila Pa 1976) 1999;24:553–60.
    1. Thomsen K, Christensen FB, Eiskjaer SP, Hansen ES, Fruensgaard S, Bunger CE. 1997 Volvo Award winner in clinical studies. The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: A prospective, randomized clinical study. Spine (Phila Pa 1976) 1997;22:2813–22.
    1. McGuire RA, Amundson GM. The use of primary internal fixation in spondylolisthesis. Spine (Phila Pa 1976) 1993;18:1662–72.
    1. Christensen FB, Karlsmose B, Hansen ES, Bünger CE. Radiological and functional outcome after anterior lumbar interbody spinal fusion. Eur Spine J. 1996;5:293–8.
    1. Johnsson R, Strömqvist B, Aspenberg P. Randomized radiostereometric study comparing osteogenic protein-1 (BMP-7) and autograft bone in human noninstrumented posterolateral lumbar fusion: 2002 Volvo Award in clinical studies. Spine (Phila Pa 1976) 2002;27:2654–61.
    1. Carragee EJ. Single-level posterolateral arthrodesis, with or without posterior decompression, for the treatment of isthmic spondylolisthesis in adults. J Bone Joint Surg Am. 1997;79:1175–80.
    1. Blume H, Rojas C. Unilateral lumbar interbody fusion (posterior approach) utilizing dowel graft. J Neurol Orthop Surg. 1981;2:171–5.
    1. Lowe TG, Tahernia AD, O’Brien MF, Smith DA. Unilateral transforaminal posterior lumbar interbody fusion (TLIF): Indications, technique, and 2-year results. J Spinal Disord Tech. 2002;15:31–8.
    1. Sonntag VK, Marciano FF. Is fusion indicated for lumbar spinal disorders? Spine (Phila Pa 1976) 1995;20(Suppl):138–42S.
    1. Stonecipher T, Wright S. Posterior lumbar interbody fusion with facet-screw fixation. Spine (Phila Pa 1976) 1989;14:468–71.
    1. Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord. 1993;6:461–72.
    1. Harm J, Jeszensky D. The unilateral transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol. 1998;6:88–99.
    1. Mehta VA, McGirt MJ, Garcés Ambrossi GL, Parker SL, Sciubba DM, Bydon A, et al. Trans-foraminal versus posterior lumbar interbody fusion: Comparison of surgical morbidity. Neurol Res. 2011;33:38–42.
    1. Humphreys SC, Hodges SD, Patwardhan AG, Eck JC, Murphy RB, Covington LA. Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine (Phila Pa 1976) 2001;26:567–71.
    1. Park J, Kim Y, Hong H, Hwang S. Comparison between posterior and transforaminal approaches for lumbar interbody fusion. J Korean Neurosurg Soc. 2005;37:340–4.
    1. Christensen FB, Laursen M, Gelineck J, Eiskjaer SP, Thomsen K, Bünger CE. Interobserver and intraobserver agreement of radiograph interpretation with and without pedicle screw implants: The need for a detailed classification system in posterolateral spinal fusion. Spine (Phila Pa 1976) 2001;26:538–44.
    1. Anekstein Y, Brosh T, Mirovsky Y. Intermediate screws in short segment pedicular fixation for thoracic and lumbar fractures: A biomechanical study. J Spinal Disord Tech. 2007;20:72–7.
    1. Guven O, Kocaoglu B, Bezer M, Aydin N, Nalbantoglu U. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures. J Spinal Disord Tech. 2009;22:417–21.
    1. Fairbank JC, Couper J, Davies JB, O›Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66:271–3.
    1. Lin PM. A technical modification of Cloward's posterior lumbar interbody fusion. Neurosurgery. 1977;1:118–24.
    1. Spruit M, Pavlov PW, Leitao J, De Kleuver M, Anderson PG, Den Boer F. Posterior reduction and anterior lumbar interbody fusion in symptomatic low-grade adult isthmic spondylolisthesis: Short-term radiological and functional outcome. Eur Spine J. 2002;11:428–33.
    1. Kwon BK, Hilibrand AS, Malloy K, Savas PE, Silva MT, Albert TJ, et al. A critical analysis of the literature regarding surgical approach and outcome for adult low-grade isthmic spondylolisthesis. J Spinal Disord Tech. 2005;18(Suppl):S30–40.
    1. Suk KS, Jeon CH, Park MS, Moon SH, Kim NH, Lee HM. Comparison between posterolateral fusion with pedicle screw fixation and anterior interbody fusion with pedicle screw fixation in adult spondylolytic spondylolisthesis. Yonsei Med J. 2001;42:316–23.
    1. Evans JH. Biomechanics of lumbar fusion. Clin Orthop Relat Res. 1985:38–46.
    1. Steffee AD, Sitkowski DJ. Posterior lumbar interbody fusion and plates. Clin Orthop Relat Res. 1988;227:99–102.
    1. Voor MJ, Mehta S, Wang M, Zhang YM, Mahan J, Johnson JR. Biomechanical evaluation of posterior and anterior lumbar interbody fusion techniques. J Spinal Disord. 1998;11:328–34.
    1. Madan S, Boeree NR. Outcome of posterior lumbar interbody fusion versus posterolateral fusion for spondylolytic spondylolisthesis. Spine (Phila Pa 1976) 2002;27:1536–42.
    1. Swan J, Hurwitz E, Malek F, van den Haak E, Cheng I, Alamin T, et al. Surgical treatment for unstable low-grade isthmic spondylolisthesis in adults: A prospective controlled study of posterior instrumented fusion compared with combined anterior-posterior fusion. Spine J. 2006;6:606–14.
    1. Audat Z, Moutasem O, Yousef K, Mohammad B. Comparison of clinical and radiological results of posterolateral fusion, posterior lumbar interbody fusion and transforaminal lumbar interbody fusion techniques in the treatment of degenerative lumbar spine. Singapore Med J. 2012;53:183–7.
    1. Harms JG, Jeszenszky D. The unilateral, transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol. 1998;6:88–99.
    1. Cole CD, McCall TD, Schmidt MH, Dailey AT. Comparison of low back fusion techniques: Transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches. Curr Rev Musculoskelet Med. 2009;2:118–26.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere