Retrospective Comparison of Radiological and Clinical Outcomes of PLIF and TLIF Techniques in Patients Who Underwent Lumbar Spinal Posterior Stabilization

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Abstract

Degenerative disc disease and spinal stenosis lead to various symptoms. Degeneration of facet joints is added to this degenerative process with aging.

Seventy-four patients who were admitted to the Spinal Column Outpatient Clinic of the Neurosurgery Department with a diagnosis of degenerative narrow spinal canal and lumbar spondylolisthesis between 2011 and 2013 and who underwent surgery were included in the study.

Our study was conducted with 74 patients of whom 73.0% (n = 54) were female and 27.0% (n = 20) were male. Mean age was 54.86 ± 7.87 years (range 34–74).

Although we did not detect a difference between the two surgical methods with regard to clinical improvement, transforaminal lumbar interbody fusion (TLIF) is preferred due to radiological advantages observed one year later, ease of application, and the development of fewer complications.

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Most cited references 17

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[A one-stager procedure in operative treatment of spondylolistheses: dorsal traction-reposition and anterior fusion (author's transl)].

J Harms, H Rolinger (1982)

On account of 41 cases of spondylolisthesis a one-stage operation for repositioning and stabilisation using Harrington's instrumentation with anterior intercorporal spine fusion is recommended. The advantage of this procedure is a secure fusion and a short hospitalisation. After 6 months the patient usually is rehabilitated.

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2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group.

, A Nordwall, O Hägg … (2001)

A randomized controlled multicenter study with a 2-year follow-up by an independent observer. To determine whether fusion of the lower lumbar spine could reduce pain and diminish disability more effectively when compared with nonsurgical treatment in patients with severe chronic low back pain (CLBP). The reported results after fusion surgery on patients with CLBP vary considerably, and the evidence of treatment efficacy is weak in the absence of randomized controlled studies. A total of 294 patients referred to 19 spinal centers from 1992 through 1998 were randomized blindly into four treatment groups. Patients aged 25-65 years with CLBP for at least 2 years and with radiologic evidence of disc degeneration at L4-L5, L5-S1, or both were eligible to participate in the study. The surgical group (n=222) included three different fusion techniques, not analyzed separately in this study. Patients in the nonsurgical group (n=72) were treated with different kinds of physical therapy. The surgical group comprised 49.5% men, and the mean age was 43 years. The corresponding figures for the nonsurgical group were 48.6% and 44 years. The patients had suffered from low back pain for a mean of 7.8 and 8.5 years and been on sick leave due to back pain for a mean of 3.2 and 2.9 years, respectively. The Visual Analogue Scale (VAS) was used to measure pain. The Oswestry Low Back Pain Questionnaire, the Million Score and the General Function Score (GFS) were used to measure disability. The Zung Depression Scale was used to measure depressive symptoms. The overall result was assessed by the patient and by an independent observer. Records from the Swedish Social Insurance were used to evaluate work disability. Patients who changed groups were included in the analyses of significance according to the intention-to-treat principle. At the 2-year follow-up 289 of 294 (98%) patients, including 25 who had changed groups, were examined. Back pain was reduced in the surgical group by 33% (64 to 43), compared with 7% (63 to 58) in the nonsurgical group (P=0.0002). Pain improved most during the first 6 months and then gradually deteriorated. Disability according to Oswestry was reduced by 25% (47 to 36) compared with 6% (48 to 46) among nonsurgical patients (P=0.015), according to Million by 28% (64 to 46) compared with 8% (66 to 60) (P=0.004), and accordingtoGFS by 31% (49 to 34) compared with 4% (48 to 46) (P=0.005). The depressive symptoms, according to Zung, were reduced by 20% (39 to 31) in the surgical group compared with 7% (39 to 36) in the nonsurgical group (P=0.123). In the surgical group 63% (122/195) rated themselves as "much better" or "better" compared with 29% (18/62) in the nonsurgical group (P<0.0001). The "net back to work rate" was significantly in favor of surgical treatment, or 36% vs. 13% (P=0.002). The early complication rate in the surgical group was 17%. Lumbar fusion in a well-informed and selected group of patients with severe CLBP can diminish pain and decrease disability more efficiently than commonly used nonsurgical treatment.

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The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care.

R Cloward (1953)

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: April 2016

Publication date (Electronic): 29 April 2016

Volume: 95

Issue: 17

Electronic Location Identifier: e3235

Affiliations

From the Department of Radiology (KA); and Department of Neurosurgery (CY), Sakarya University Training and Research Hospital, Sakarya, Turkey.

Author notes

Correspondence: Can Yaldiz, MD, Department of Neurosurgery, Sakarya University Training and Research Hospital, Sakarya 54110, Turkey (e-mail: drcanyaldiz@ 123456yahoo.com ).

Article

Accession ID: 03235

DOI: 10.1097/MD.0000000000003235

PMC ID: 4998679

PubMed ID: 27124016

SO-VID: 4562e07a-8006-4c0e-99bb-5076d813ef05

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This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0

History

Date received : 18 January 2016

Date revision received : 23 February 2016

Date accepted : 25 February 2016

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Retrospective Comparison of Radiological and Clinical Outcomes of PLIF and TLIF Techniques in Patients Who Underwent Lumbar Spinal Posterior Stabilization

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Most cited references 17

[A one-stager procedure in operative treatment of spondylolistheses: dorsal traction-reposition and anterior fusion (author's transl)].

2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group.

The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care.

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