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

Background Data: Surgical treatment of isthmic spondylolisthesis includes decompression, fixation and bone fusion. There are different suitable techniques for fusion as (PLF) posterolateral fusion (TLIF) transforaminal lumbar interbody fusion, (PLIF) posterior lumbar interbody fusion, (ALIF) anterio...

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Autores principales:	Ashraf Mohamed Farid, MD., Ahmed Rizk Elkholy, MD.
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2018
Materias:	Posterolateral Fusion Transforaminal Lumbar Interbody Fusion Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/f5c7f195de4f44e7a8117e0e185de90d
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spelling	oai:doaj.org-article:f5c7f195de4f44e7a8117e0e185de90d2021-12-02T04:30:05ZPosterolateral Fusion versus Transforaminal Lumbar Interbody Fusion in the Surgical Treatment of Low-Grade Isthmic Spondylolisthesis10.21608/esj.2018.183902314-89692314-8950https://doaj.org/article/f5c7f195de4f44e7a8117e0e185de90d2018-07-01T00:00:00Zhttp://www.esj.journals.ekb.eg/article_18390.htmlhttps://doaj.org/toc/2314-8969https://doaj.org/toc/2314-8950Background Data: Surgical treatment of isthmic spondylolisthesis includes decompression, fixation and bone fusion. There are different suitable techniques for fusion as (PLF) posterolateral fusion (TLIF) transforaminal lumbar interbody fusion, (PLIF) posterior lumbar interbody fusion, (ALIF) anterior lumbar interbody fusion but still controversy remains about the best technique. Purpose: To evaluate and compare the surgical results of PLF versus TLIF with pedicle screw fixation in treatment of low-grade isthmic spondylolisthesis. Study design: A prospective randomized clinical case series. Patients and methods: This study included 40 patients with low grade isthmic spondylolisthesis. All patients were surgically treated by posterior decompression, transpedicular screw fixation and bone fusion. Patients were divided into two equal groups according to the type of bone fusion. Group A included 20 patients treated with PLF, and Group B included another 20 patients and were treated with TLIF. We used Visual Analogue Scale (VAS) for assess pain and the Oswestry Disability Index (ODI) to evaluate the functional outcome among our patients. Patients have been followed up for at least six months after surgery. Results: The improvement of VAS of back pain was significantly greater in group B (TLIF) (change 5.251.55) than in group A (PLF) (change, 4.41.14) (P<0.05). There was no significant difference in improvement of ODI in both groups. Patients with BMI30 showed that group B experienced more clinical improvement than in group A in the VAS (P=0.021). The operative time in group B (18524.5 min) was significantly longer than in group A (123.319.6 min) (P=0.034). Intraoperative blood loss in group B (584192.1 ml) was significantly greater than in group A (417182.4 ml) (P=0.008). The complication rate in group A (30%) was significantly less than in group B (55%) (P= 0.032) but broken screws (hardware failure) were more common in group A (20%) than in group B (0.0%) (P=0.01). The fusion rate in group B (95%) was higher than in group A (75%). Conclusion: Our data suggest that although TLIF is better than PLF in achievement of successful bone fusion and improvement of patient's symptoms (back pain and sciatica), PLF still considered simple technique with minimal operative blood loss, less operative time and little complications. (2018ESJ162) Ashraf Mohamed Farid, MD.Ahmed Rizk Elkholy, MD.Egyptian Spine AssociationarticlePosterolateral FusionTransforaminalLumbar Interbody FusionNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 27, Iss 1, Pp 48-56 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Posterolateral Fusion Transforaminal Lumbar Interbody Fusion Neurology. Diseases of the nervous system RC346-429
spellingShingle	Posterolateral Fusion Transforaminal Lumbar Interbody Fusion Neurology. Diseases of the nervous system RC346-429 Ashraf Mohamed Farid, MD. Ahmed Rizk Elkholy, MD. Posterolateral Fusion versus Transforaminal Lumbar Interbody Fusion in the Surgical Treatment of Low-Grade Isthmic Spondylolisthesis
description	Background Data: Surgical treatment of isthmic spondylolisthesis includes decompression, fixation and bone fusion. There are different suitable techniques for fusion as (PLF) posterolateral fusion (TLIF) transforaminal lumbar interbody fusion, (PLIF) posterior lumbar interbody fusion, (ALIF) anterior lumbar interbody fusion but still controversy remains about the best technique. Purpose: To evaluate and compare the surgical results of PLF versus TLIF with pedicle screw fixation in treatment of low-grade isthmic spondylolisthesis. Study design: A prospective randomized clinical case series. Patients and methods: This study included 40 patients with low grade isthmic spondylolisthesis. All patients were surgically treated by posterior decompression, transpedicular screw fixation and bone fusion. Patients were divided into two equal groups according to the type of bone fusion. Group A included 20 patients treated with PLF, and Group B included another 20 patients and were treated with TLIF. We used Visual Analogue Scale (VAS) for assess pain and the Oswestry Disability Index (ODI) to evaluate the functional outcome among our patients. Patients have been followed up for at least six months after surgery. Results: The improvement of VAS of back pain was significantly greater in group B (TLIF) (change 5.251.55) than in group A (PLF) (change, 4.41.14) (P<0.05). There was no significant difference in improvement of ODI in both groups. Patients with BMI30 showed that group B experienced more clinical improvement than in group A in the VAS (P=0.021). The operative time in group B (18524.5 min) was significantly longer than in group A (123.319.6 min) (P=0.034). Intraoperative blood loss in group B (584192.1 ml) was significantly greater than in group A (417182.4 ml) (P=0.008). The complication rate in group A (30%) was significantly less than in group B (55%) (P= 0.032) but broken screws (hardware failure) were more common in group A (20%) than in group B (0.0%) (P=0.01). The fusion rate in group B (95%) was higher than in group A (75%). Conclusion: Our data suggest that although TLIF is better than PLF in achievement of successful bone fusion and improvement of patient's symptoms (back pain and sciatica), PLF still considered simple technique with minimal operative blood loss, less operative time and little complications. (2018ESJ162)
format	article
author	Ashraf Mohamed Farid, MD. Ahmed Rizk Elkholy, MD.
author_facet	Ashraf Mohamed Farid, MD. Ahmed Rizk Elkholy, MD.
author_sort	Ashraf Mohamed Farid, MD.
title	Posterolateral Fusion versus Transforaminal Lumbar Interbody Fusion in the Surgical Treatment of Low-Grade Isthmic Spondylolisthesis
title_short	Posterolateral Fusion versus Transforaminal Lumbar Interbody Fusion in the Surgical Treatment of Low-Grade Isthmic Spondylolisthesis
title_full	Posterolateral Fusion versus Transforaminal Lumbar Interbody Fusion in the Surgical Treatment of Low-Grade Isthmic Spondylolisthesis
title_fullStr	Posterolateral Fusion versus Transforaminal Lumbar Interbody Fusion in the Surgical Treatment of Low-Grade Isthmic Spondylolisthesis
title_full_unstemmed	Posterolateral Fusion versus Transforaminal Lumbar Interbody Fusion in the Surgical Treatment of Low-Grade Isthmic Spondylolisthesis
title_sort	posterolateral fusion versus transforaminal lumbar interbody fusion in the surgical treatment of low-grade isthmic spondylolisthesis
publisher	Egyptian Spine Association
publishDate	2018
url	https://doaj.org/article/f5c7f195de4f44e7a8117e0e185de90d
work_keys_str_mv	AT ashrafmohamedfaridmd posterolateralfusionversustransforaminallumbarinterbodyfusioninthesurgicaltreatmentoflowgradeisthmicspondylolisthesis AT ahmedrizkelkholymd posterolateralfusionversustransforaminallumbarinterbodyfusioninthesurgicaltreatmentoflowgradeisthmicspondylolisthesis
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Posterolateral Fusion versus Transforaminal Lumbar Interbody Fusion in the Surgical Treatment of Low-Grade Isthmic Spondylolisthesis

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