PDF
ePub
Citation
Print
Abstract
Study design
This was a retrospective study that analyzed and compared the results between a posterior lumbar interbody fusion, and a posterolateral fusion (PLIF+PLF), and PLF alone, in the treatment of spondyolytic spondylolisthesis in adults.
Objectives
To evaluate the outcomes of two surgical treatment methods for spondylolytic spondylolisthesis- posterolateral fusion alone, and circumferential fusion, using posterior lumbar interbody fusion and posterolateral fusion.
Summary of Literature Review
There have been many reports regarding the surgical treatment of spondylolisthesis. Posterior lumbar interbody fusions have certain distinct mechanical advantages over posterolateral ones. However, the clinical and radio-logical results do not usually correlate.
Materials and Methods
Between January 1998 and December 2001, 38 patients, with spondylolytic spondylolisthesis, were operated on by a single surgeon. Nineteen patients underwent a posterolateral fusion alone (group I), with the same number undergoing an additional posterior lumbar interbody fusion (group II). These two groups were evaluated for their clinical outcomes, radiological measurements and fusion rates.
Results
The losses in the slip reduction were 7.1 and 1.3% in the PLF and PLF+PLIF groups, respectively (P<0.05). The losses in the Meschan angle were 3.3 and 0.2 in the PLF and PLF+PLIF groups, respectively (P<0.05). The losses in the disc height restoration were 10.4 and 3.8% in the PLF and PLF+PLIF groups, respectively (P<0.05). A nonunion was observed in 3 of the PLF cases (15.8%) and 1 of the PLF+PLIF (5.3%). However, the satisfactory clinical results were 84.2 and 73.7% in the PLF and PLF+PLIF groups, respectively (P>0.05).
Conclusions
A lthough the addition of a posterior lumbar interbody fusion, to an instrumented posterolateral fusion, following decompression, is more predictable in maintaining a correction and achieving union, a posterolateral fusion may have a better clinical outcome in patients with low grade spondylolytic spondylolisthesis. Therefore, careful patient selection is necessary for each operation.
REFERENCES
01). Banwart IC., Asher MA., Hassamein RS. Iliac crest bone graft harvest donor site morbidity. A statistical eval -uation. Spine,. 20:1055–1060. 1995.
02). Brantigan JW., Steffee AD., Geiger JM. A carbon fiber implant to aid interbody fusion. Mechanical testing. Spine,. 16:S277–285. 1991.
03). Brantigan JW. Pseudoarthrosis rate after allograft pos -terior lumbar interbody fusion with pedicle screw and plate fixation. Spine,. 19:1271–1280. 1994.
04). Carragee EJ. Single-level posterolateral arthrodesis, with or without posterior decompression, for the treatment of isthmic spondylolisthesis in adults. A prospective, ran -domized study. J Bone Joint Surg,. 79-A:1175–1180. 1997.
05). Choy WS., Kim WJ., Kim KH., Kim YW., Keum TS., Lee BK., Ryu CS. The results of the posterior lumbar interbody fusion using Titanium mesh cage for spondy -lolisthesis. J Kor Spine Surg,. 6(1):129–134. 1999.
06). Chung JY., Choi BH. Posterior lumbar interbody fusion with transpedicular instrumentation after reduction of spondylolisthesis. J of Korean Orthop Assoc,. 27:1358–1366. 1992.
07). Chung JY., Seo HY., Kim JS. The results and affecting factors of posterior lumbar interbody fusion with TPM cages in spondylolisthesis. J of Kor Spine Surg,. 7(4):586–596. 2000.
08). Deguchi M., Rapoff AJ., Zdeblick TA. posterolateral fusion for isthmic spondylolisthesis in adults: analysis of fusion rate and clinical results. J Spinal Disord,. 11(6):459–464. 1998.
09). De Loubresse CG., Bon T., Deburge A., Lassale B., Benoit M. Posterolateral fusion for radicular pain in isthmic spondylolisthesis. Clin Orthop,. 323:194–201. 1996.
10). Esses SI., Natout N., Kip P. Posterior interbody arthrodesis with a fibular strut graft in spondylolisthesis. J Bone Joint Surg,. 77-A:172–176. 1995.
11). Fredrickson BE., Baker D., Mcholick WJ., Yuan HA., Lubicky JP. The natural history of spondyolysis and spondylolisthesis. J Bone Joint Surg,. 68-B:595–599. 1986.
12). Freeman BJC., Licina P., Mehdian SH. Posterio r lumbar interbody fusion combined with instrumented pos -terolateral fusion: 5-year results in 60 patients. Eur Spine J,. 9:42–46. 2000.
13). Fujiya M., Saita M., Kaneda K., Albumi K. Clinical study on stability of combined distraction and compression rod instrumentation with posterolateral fusion for unstable degenerative spondylolisthesis. Spine,. 15:1216–1222. 1990.
14). Gill CG., Manning JG., White HL. Surgical treat -ment of spondylolisthesis without fusion. J Bone Joint Surg,. 37-A:493–520. 1955.
15). Gyorgy I., Csecsei ph D., Almos P. Klekner M.D.., Jozsef Dobal M.D.., Attila Lajgut M.D.., Judit Sikula M.D.Posterior interbody fusion using laminectomy bone and transpedicular screw fixation in the lumbar spondylolis -thesis. Spine,. 53:2–7. 2000.
16). Isadore Meschan MD. A radiographic study of spondylolisthesis with special reference to stability deter -mination. Radiology, vol. 47:249–262. 1946.
17). James C. H. Goh, Hee-kit Wong, Ashvin Thambyah, and Chun-Sing Yu. Influence of PLIF cage size on lum -bar spine stability. Spine,. 25(1):35–45. 2000.
18). Jan Verlooy, Kris De Smedt, and Paul Selosse. Failure of a modified posterior lumbar interbody fusion technique to produce adequate pain relief in isthmic spondylolytic grade 1 spondylolisthesis patient. A prospective study of 20 patents. Spine,. 18:1491–1495. 1993.
19). Kim EH., Song IS. Additional posterior lumbar inter -body fusion using threaded cage in spondylolisthesis with instability. J of Kor Spine Surg,. 7(4):544–551. 2000.
20). Kim EH., Woo BC., Koh ES., Cho DY. The change of segmental sagittal angle in low-grade spondylolisthesis after pedicular screw fixation with or without PLIF. -PLIF+PLF versus PLF groups-J of Korean Orthop Assoc,. 32(4):1098–1106. 1997.
21). Kim NH., Kim DJ. Anterior interbody fusion for spondylolisthesis. Orthopaedics,. 14(10):1069–1076. 1991.
22). Kim SS., Denis F., Lonstein JE., Winter RB. Factors affecting fusion rate in adult spondylolisthesis. Spine,. 15:979–983. 1990.
23). Kluger P., Weidt F., Puhl W. spondylolisthesis and pseudospondylolisthesis. Treatment by segmental reposition and interbody fusion with fixateur interne. Orthopade. 26(9):790–795. 1997.
24). Laursen M., Thomsen K., Eiskjaer SP., Hansen ES., Bunger CE. Functional outcome after partial reduction and 360 degree fusion in grade III-V spondylolisthesis in adolescent and adult patient. J Spinal Disord,. 12(4):300–306. 1999.
25). Lenke LG., Birdwell KH., Bullis D., Betz RR., Baldus C., and Schoenecker PL. Results of in situ fusion for isthmic spondylolisthesis. J Spinal Disord,. 5:433–441. 1992.
26). Lin PM., Cautilli BA., Joice MF. Posterior lumbar interbody fusion. Clin Orthop,. 180:154–168. 1983.
27). Madan S., Boeree NR. Outcome of posterior lumbar interbody fusion versus posterolateral fusion for spondy -lolytic spondylolisthesis. Spine,. 27(14):1536–1542. 2002.
28). Park JT., Shin YS., Yang JH., Seo BG. The fusion rate and clinical effect of PLIF with laminected lamina and spinous process. J of Kor Spine Surg,. 5(1):79–85. 1998.
29). Rothman RH., Simeone FA. The spine. 3rd ed.Philadelphia: WB Saunders Co;p. 913–969. 1992.
30). Rubelli MU., Grob D. Fusion of spondylolisthesis. Spine, State of art reviews,. 6:577–592. 1992.
31). Shin BJ., Kim DI., Choi CU. Treatment of lumbar disease with posterior lumbar interbody fusion.-Instru -mented versus Non-instrumented groups- J of Kor Spine Surg,. 2(1):106–113. 1995.
32). Shin BJ., Kim GJ., Ha SS., Chung SH., Kwon H., Kim YI. Posterior lumbar interbody fusion using laminar bone block. J of Kor Spine Surg,. 6(1):110–116. 1999.
33). Shin BJ., Min KD., Kwon H., Lee BI., Kim YI., Rah SK., Choi CU. Surgical result of isthmic spondylolisthe -sis.-Comparison of posterolateral fusion vs PLIF- J of Kor Spine Surg,. 3(1):61–68. 1996.
34). Song KJ., Kim SJ. Surgical treatment for the low grade lumbar isthmic spondylolisthesis.-Comparison between posterolateral fusion and posterior lumbar inter -body fusion- J of Kor Spine Surg,. 6(1):96–103. 1999.
35). Steffe AD., Sitkowski DJ. Reduction and Stabilization of grade IV spondylolisthesis. Clin Orthop,. 227:82–89. 1988.
36). 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 spondylolis -thesis. Yonsei Med J,. 42:316–323. 2001.
37). Suk SI., Lee CK., Kim WJ., Lee JH., Cho KJ., Kim HG. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine,. 22(2):210–219. 1997.
38). Taillard W. Etiology of spondylolisthesis. Clin Orthop,. 117:30–39. 1976.
39). Tiusanen H., Schlenzka D., Seitsalo S., Poussa M., Osterman K. Results of a trial of anterior or circumfer -ential lumbar fusion in the treatment of severe isthmic spondylolisthesis in young. J Pediatr Orthop B,. 5(3):190–194. 1996.
40). Wang JM., Kim DJ., Yun YH. posterior pedicular screw instrumentation and anterior interbody fusion in adult lumbar spondylolysis or grade I spondylolisthesis with segmental instability. J Spinal Disord,. 9(2):83–88. 1996.
Table 1.
Patients data
Table 2.
Criteria for clinical results
Table 3.
Clinical results (Kim et al, 1991)21
| PLF group (%) | PLF + PLIF group (%) | |
|---|---|---|
| Excellent | 7(36.8) | 4(21.1) |
| Good | 9(47.4) | 10(52.6) |
| Fair | 2(10.5) | 3(15.8) |
| Poor | 1(5.3) | 2(10.5) |
Table 4.
Changes of slip(%)
| Preop | Postop | Last F/U | Correction degree∗ | Loss of correction † | |
|---|---|---|---|---|---|
| PLF | 20.4 | 10.8 | 17.9 | 9.6 | 7.1 |
| PLF + PLIF | 19.4 | 9.0 | 10.3 | 10.4 | 1.3 |
XML Download