Posterolateral Fusion versus Transforaminal Lumbar Interbody Fusion in the Surgical Treatment of Low-Grade Isthmic Spondylolisthesis

Background: Spondylolisthesis is anterior translation of the cephalad vertebra relative to the adjacent caudal segment. Both posterolateral fusion (PLF) and transforaminal lumbar interbody fusion (TLIF) and have shown high fusion rates with good clinical outcomes. But it is not clear which treatment leads to better outcomes, as limited studies have been done to compare PLF and TLIF in low grade spondylolisthesis. Our objective is to determine whether PLF or TLIF was associated with better clinical and radiological outcomes in patients with low grade spondylolisthesis.Methods: Fourty patients were enrolled and assigned into PLF (n=20) or TLIF (n=20) group. The outcome measures were: clinical outcomes as assessed with a visual analogue scale and the modified Oswestry disability index, the fusion rate based on radiographs.Results: The improvement of visual analog score (VAS) of low back pain was greater in TLIF than in PLF (89.6% versus 88.7%, p=0.79). The improvement of VAS of leg pain was greater in TLIF than in PLF (96.5% versus 94.8%; p=0.27). The improvement of Oswestry disability index (ODI) was greater in TLIF than in PLF (71.7% vs 69.8%, p=0.32). The fusion rate was 85% in TLIF and 75% in PLF (p=0.43). Overall outcome was excellent in 80% in TLIF compared to 65% in PLF (p=0.29).Conclusions: Fusion rates are higher in TLIF and average functional outcomes (VAS and ODI) were better in TLIF compared to PLF. Larger and longer studies may provide a significant outcome. Based on our results and literature review, we conclude that TLIF is superior to PLF.

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Fueling the debate: Are outcomes better after posterior lumbar interbody fusion (PLIF) or after posterolateral fusion (PLF) in adult patients with low-grade adult isthmic spondylolisthesis?

Evidence-Based Spine-Care Journal ◽

10.1055/s-0028-1100890 ◽

2010 ◽

Vol 1 (01) ◽

pp. 29-34 ◽

Cited By ~ 6

Author(s):

G Bròdano ◽

F Lolli ◽

K Martikos ◽

A Gasbarrini ◽

S Bandiera ◽

...

Keyword(s):

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Adult Patients ◽

Posterolateral Fusion ◽

Low Grade ◽

Lumbar Interbody Fusion ◽

Isthmic Spondylolisthesis

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Direct Pars Defect Tubular Decompression and TLIF for the Treatment of Low-Grade Adult Isthmic Spondylolisthesis: Surgical Challenges and Nuances of a Muscle-Sparing Minimally Invasive Approach

Minimally Invasive Surgery ◽

10.1155/2020/5346805 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Fabio Roberti ◽

Katie Arsenault

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Low Grade ◽

Lumbar Interbody Fusion ◽

Isthmic Spondylolisthesis ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Muscle Sparing

We present an illustrative report on the use of a minimally invasive, muscle-sparing, direct pars defect decompression with transforaminal lumbar interbody fusion (TLIF) and instrumentation for the treatment of low-grade adult isthmic spondylolysis with spondylolisthesis and discuss the surgical challenges and nuances associated with the technique.

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Posterior lumbar interbody fusion versus posterolateral fusion with instrumentation in the treatment of low-grade isthmic spondylolisthesis: midterm clinical outcomes

Journal of Neurosurgery Spine ◽

10.3171/2010.11.spine10281 ◽

2011 ◽

Vol 14 (4) ◽

pp. 488-496 ◽

Cited By ~ 42

Author(s):

Ahmet Murat Müslüman ◽

Adem Yılmaz ◽

Tufan Cansever ◽

Halit Çavuşoğlu ◽

İbrahim Çolak ◽

...

Keyword(s):

Clinical Outcomes ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Posterolateral Fusion ◽

Low Grade ◽

Lumbar Interbody Fusion ◽

Isthmic Spondylolisthesis ◽

Transpedicular Instrumentation ◽

Lumbar Spondylolisthesis

Object The purpose of this study was to compare the methods of posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) in cases of isthmic Grades 1 and 2 lumbar spondylolisthesis, and to evaluate the clinical efficacy of the procedures. Methods Operations were performed in 50 patients with lumbar spondylolisthesis in the authors' clinics between 2001 and 2007. Indications for surgery were low-back pain with or without sciatica and neurogenic claudication that had not improved after at least 6 months of conservative treatment. The study included 33 female and 17 male patients, with mean ages of 50.6 years in the PLIF group and 47.3 years in the PLF group. These patients were randomly allocated into 2 groups: decompression, posterior transpedicular instrumentation, and PLF (Group 1; 25 patients) and decompression, posterior transpedicular instrumentation, and PLIF (Group 2; 25 patients). In the PLIF group, titanium cages were used, and autograft material was obtained from the decompression. In the PLF group, bone fragments collected from the iliac crest were used as autografts. A minimum 18-month follow-up was available in all patients. For clinical evaluation, a visual analog scale, Oswestry Disability Index, and the 36-Item Short Form Health Survey were used. Improvements in pre- and postoperative spondylolisthesis, segmental angles, fusion ratios, and postoperative complications were evaluated radiologically. Results The average follow-up period was 3.3 years. Based on the etiologies, isthmic spondylolisthesis was detected in all patients. The spondylolisthesis levels in the patients who underwent PLIF were located at L3–4 (5 patients, 20%); L4–5 (14, 56%); and L5–S1 (6, 24%), whereas the levels in the ones treated with PLF were located at L3–4 (4 patients, 16%); L4–5 (13, 52%); and L5–S1 (8, 32%). In the clinical evaluations, good or excellent results were obtained in 22 (88%) cases in the PLIF group and 19 (76%) cases in the PLF group. Fusion ratios were 100% in the PLIF group and 84% in the PLF group. Both lumbar lordosis and the segmental angle showed greater improvement in the PLIF group. There was no difference in the complication rates for each group. Conclusions Based on early clinical outcomes and the fusion ratios of adult isthmic spondylolisthesis, the authors found PLIF to be superior to PLF.

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