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Comparison of Clinical and Radiological Results of Posterolateral Fusion and Posterior Lumbar Interbody Fusion in the Treatment of L4 Degenerative Lumbar Spondylolisthesis.

Kuraishi S, Takahashi J, Mukaiyama K, Shimizu M, Ikegami S, Futatsugi T, Hirabayashi H, Ogihara N, Hashidate H, Tateiwa Y, Kinoshita H, Kato H - Asian Spine J (2016)

Bottom Line: Radiographic findings and clinical outcomes evaluated by the Japanese Orthopaedic Association (JOA) score were compared between the two groups.Correction of slip estimated from postoperative slip angle, translation, and maintenance of intervertebral disc height in the PLIF group was significantly (p<0.05) better than those in the PLF group.However, there was no significant difference in lumbar lordotic angle, slip angle and translation angle upon maximum flexion, or extension bending.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.

ABSTRACT

Study design: Multicenter analysis of two groups of patients surgically treated for degenerative L4 unstable spondylolisthesis.

Purpose: To compare the clinical and radiographic outcomes of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) for degenerative L4 unstable spondylolisthesis.

Overview of literature: Surgery for lumbar degenerative spondylolisthesis is widely performed. However, few reports have compared the outcome of PLF to that of PLIF for degenerative L4 unstable spondylolisthesis.

Methods: Patients with L4 unstable spondylolisthesis with Meyerding grade II or more, slip of >10° or >4 mm upon maximum flexion and extension bending, and posterior opening of >5 degree upon flexion bending were studied. Patients were treated from January 2008 to January 2010. Patients who underwent PLF (n=12) and PLIF (n=19) were followed-up for >2 years. Radiographic findings and clinical outcomes evaluated by the Japanese Orthopaedic Association (JOA) score were compared between the two groups. Radiographic evaluation included slip angle, translation, slip angle and translation during maximum flexion and extension bending, intervertebral disc height, lumbar lordotic angle, and fusion rate.

Results: JOA scores of the PLF group before surgery and at final follow-up were 12.3±4.8 and 24.1±3.7, respectively; those of the PLIF group were 14.7±4.8 and 24.2±7.8, respectively, with no significant difference between the two groups. Correction of slip estimated from postoperative slip angle, translation, and maintenance of intervertebral disc height in the PLIF group was significantly (p<0.05) better than those in the PLF group. However, there was no significant difference in lumbar lordotic angle, slip angle and translation angle upon maximum flexion, or extension bending. Fusion rates of the PLIF and PLF groups had no significant difference.

Conclusions: The L4-L5 level posterior instrumented fusion for unstable spondylolisthesis using both PLF and PLIF could ameliorate clinical symptoms when local stability is achieved.

No MeSH data available.


Related in: MedlinePlus

(A, B) Radiologic data on maximum flexion and extension. Preoperative instability on maximum flexion and extension was stronger in the PLIF group. However, the PLF group showed instability at 3 and 6 months postoperatively compared to the PLIF group. The instability in the maximum flexion and extension disappeared in both groups. Preop., preoperative; PLIF, posterior lumbar interbody fusion; PLF, posterior lumbar fusion. *p<0.05, **p<0.01.
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Figure 5: (A, B) Radiologic data on maximum flexion and extension. Preoperative instability on maximum flexion and extension was stronger in the PLIF group. However, the PLF group showed instability at 3 and 6 months postoperatively compared to the PLIF group. The instability in the maximum flexion and extension disappeared in both groups. Preop., preoperative; PLIF, posterior lumbar interbody fusion; PLF, posterior lumbar fusion. *p<0.05, **p<0.01.

Mentions: The preoperative slip angles on maximum flexion and extension in the PLF and PLIF groups were 8.0°±5.3° and 12.0°±5.1°, respectively (p=0.04). The PLIF group was significantly unstable. However, at 3 months postoperatively, the values were 5.7°±3.4° and 1.9°±2.5°, respectively (p=0.02). At 6 months postoperatively, the values were 3.9°±2.3° and 1.5°±1.7°, respectively (p=0.02). Thus, the slip angle of the PLIF group was more limited. However, at the final follow-up, the slip angles of the PLF and PLIF groups were 3.3°±1.6° and 3.1°±2.4°, respectively (p=0.8) (Fig. 5A). Preoperative translation on maximum flexion and extension in the PLF and PLIF groups were 2.3±1.4mm and 3.9±2.5 mm, respectively (p=0.1). At 3 months postoperatively, the values were 2.2±1.3 mm and 0.9±1.0 mm, respectively (p=0.04). Thus, the PLIF group showed significantly limited translation in motion. However, there was no significant difference at 6 months postoperatively or at the final follow-up (PLF and PLIF group: 2.0±1.8 mm and 1.6±1.7 mm, respectively, p=0.5) (Fig. 5B). The fusion rates of the PLF and PLIF groups were 72.3% and 89.5%, respectively (p>0.05) (Fig. 6).


Comparison of Clinical and Radiological Results of Posterolateral Fusion and Posterior Lumbar Interbody Fusion in the Treatment of L4 Degenerative Lumbar Spondylolisthesis.

Kuraishi S, Takahashi J, Mukaiyama K, Shimizu M, Ikegami S, Futatsugi T, Hirabayashi H, Ogihara N, Hashidate H, Tateiwa Y, Kinoshita H, Kato H - Asian Spine J (2016)

(A, B) Radiologic data on maximum flexion and extension. Preoperative instability on maximum flexion and extension was stronger in the PLIF group. However, the PLF group showed instability at 3 and 6 months postoperatively compared to the PLIF group. The instability in the maximum flexion and extension disappeared in both groups. Preop., preoperative; PLIF, posterior lumbar interbody fusion; PLF, posterior lumbar fusion. *p<0.05, **p<0.01.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4764527&req=5

Figure 5: (A, B) Radiologic data on maximum flexion and extension. Preoperative instability on maximum flexion and extension was stronger in the PLIF group. However, the PLF group showed instability at 3 and 6 months postoperatively compared to the PLIF group. The instability in the maximum flexion and extension disappeared in both groups. Preop., preoperative; PLIF, posterior lumbar interbody fusion; PLF, posterior lumbar fusion. *p<0.05, **p<0.01.
Mentions: The preoperative slip angles on maximum flexion and extension in the PLF and PLIF groups were 8.0°±5.3° and 12.0°±5.1°, respectively (p=0.04). The PLIF group was significantly unstable. However, at 3 months postoperatively, the values were 5.7°±3.4° and 1.9°±2.5°, respectively (p=0.02). At 6 months postoperatively, the values were 3.9°±2.3° and 1.5°±1.7°, respectively (p=0.02). Thus, the slip angle of the PLIF group was more limited. However, at the final follow-up, the slip angles of the PLF and PLIF groups were 3.3°±1.6° and 3.1°±2.4°, respectively (p=0.8) (Fig. 5A). Preoperative translation on maximum flexion and extension in the PLF and PLIF groups were 2.3±1.4mm and 3.9±2.5 mm, respectively (p=0.1). At 3 months postoperatively, the values were 2.2±1.3 mm and 0.9±1.0 mm, respectively (p=0.04). Thus, the PLIF group showed significantly limited translation in motion. However, there was no significant difference at 6 months postoperatively or at the final follow-up (PLF and PLIF group: 2.0±1.8 mm and 1.6±1.7 mm, respectively, p=0.5) (Fig. 5B). The fusion rates of the PLF and PLIF groups were 72.3% and 89.5%, respectively (p>0.05) (Fig. 6).

Bottom Line: Radiographic findings and clinical outcomes evaluated by the Japanese Orthopaedic Association (JOA) score were compared between the two groups.Correction of slip estimated from postoperative slip angle, translation, and maintenance of intervertebral disc height in the PLIF group was significantly (p<0.05) better than those in the PLF group.However, there was no significant difference in lumbar lordotic angle, slip angle and translation angle upon maximum flexion, or extension bending.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.

ABSTRACT

Study design: Multicenter analysis of two groups of patients surgically treated for degenerative L4 unstable spondylolisthesis.

Purpose: To compare the clinical and radiographic outcomes of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) for degenerative L4 unstable spondylolisthesis.

Overview of literature: Surgery for lumbar degenerative spondylolisthesis is widely performed. However, few reports have compared the outcome of PLF to that of PLIF for degenerative L4 unstable spondylolisthesis.

Methods: Patients with L4 unstable spondylolisthesis with Meyerding grade II or more, slip of >10° or >4 mm upon maximum flexion and extension bending, and posterior opening of >5 degree upon flexion bending were studied. Patients were treated from January 2008 to January 2010. Patients who underwent PLF (n=12) and PLIF (n=19) were followed-up for >2 years. Radiographic findings and clinical outcomes evaluated by the Japanese Orthopaedic Association (JOA) score were compared between the two groups. Radiographic evaluation included slip angle, translation, slip angle and translation during maximum flexion and extension bending, intervertebral disc height, lumbar lordotic angle, and fusion rate.

Results: JOA scores of the PLF group before surgery and at final follow-up were 12.3±4.8 and 24.1±3.7, respectively; those of the PLIF group were 14.7±4.8 and 24.2±7.8, respectively, with no significant difference between the two groups. Correction of slip estimated from postoperative slip angle, translation, and maintenance of intervertebral disc height in the PLIF group was significantly (p<0.05) better than those in the PLF group. However, there was no significant difference in lumbar lordotic angle, slip angle and translation angle upon maximum flexion, or extension bending. Fusion rates of the PLIF and PLF groups had no significant difference.

Conclusions: The L4-L5 level posterior instrumented fusion for unstable spondylolisthesis using both PLF and PLIF could ameliorate clinical symptoms when local stability is achieved.

No MeSH data available.


Related in: MedlinePlus