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Comparison of the early results of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in symptomatic lumbar instability

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Abstract

Background

Transforaminal lumbar interbody fusion (TLIF) has been preferred to posterior lumbar interbody fusion (PLIF) for different spinal disorders but there had been no study comparing their outcome in lumbar instability. A comparative retrospective analysis of the early results of TLIF and PLIF in symptomatic lumbar instability was conducted between 2005 and 2011.

Materials and Methods

Review of the records of 102 operated cases of lumbar instability with minimum 1 year followup was done. A total of 52 cases (11 men and 41 women, mean age 46 years SD 05.88, range 40-59 years) underwent PLIF and 50 cases (14 men and 36 women, mean age 49 years SD 06.88, range 40-59 years) underwent TLIF. The surgical time, duration of hospital stay, intraoperative blood loss were compared. Self-evaluated low back pain and leg pain status (using Visual Analog Score), disability outcome (using Oswestry disability questionnaire) was analyzed. Radiological structural restoration (e.g., disc height, foraminal height, lordotic angle, and slip reduction), stability (using Posner criteria), fusion (using Hackenberg criteria), and overall functional outcome (using MacNab’s criteria) were compared.

Results

Pain, disability, neurology, and overall functional status were significantly improved in both groups but PLIF required more operative time and caused more blood loss. Postoperative hospital stay, structural restoration, stability, and fusion had no significant difference but neural complications were relatively more with PLIF.

Conclusions

Both methods were effective in relieving symptoms, achieving structural restoration, stability, and fusion, but TLIF had been associated with shorter operative time, less blood loss, and lesser complication rates for which it can be preferred for symptomatic lumbar instability.

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References

  1. Guillot M, Fournier J, Scheye T, Escande G, Chazal J, Tanguy A, et al. Mechanics of the characteristic geometry of the human spine undergoing vertical pressure. Bull Assoc Anat (Nancy) 1990;74:7–8.

    CAS  Google Scholar 

  2. Alqarni AM, Schneiders AG, Hendrick PA. Clinical tests to diagnose lumbar segmental instability: A systematic review. J Orthop Sports Phys Ther 2011;41:130–40.

    Article  PubMed  Google Scholar 

  3. Posner I, White AA 3rd, Edwards WT, Hayes WC. A biomechanical analysis of the clinical stability of the lumbar and lumbosacral spine. Spine (Phila Pa 1976) 1982;7:374–89.

    Article  CAS  Google Scholar 

  4. Fritz JM, Erhard RE, Hagen BF. Segmental instability of the lumbar spine. Phys Ther 1998;78:889–96.

    Article  CAS  PubMed  Google Scholar 

  5. Sonntag VK, Marciano FF. Is fusion indicated for lumbar spinal disorders? Spine (Phila Pa 1976) 1995;20:138s–42s.

    Article  CAS  Google Scholar 

  6. Stonecipher T, Wright S. Posterior lumbar interbody fusion with facet-screw fixation. Spine (Phila Pa 1976) 1989;14:468–71.

    Article  CAS  Google Scholar 

  7. Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 1993;6:461–72.

    Article  CAS  PubMed  Google Scholar 

  8. West JL 3rd, Bradford DS, Ogilvie JW. Results of spinal arthrodesis with pedicle screw-plate fixation. J Bone Joint Surg Am 1991;73:1179–84.

    Article  PubMed  Google Scholar 

  9. Harm J, Jeszensky D. The unilateral transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol 1998;6:88–99.

    Google Scholar 

  10. Mehta VA, McGirt MJ, Garcés Ambrossi GL, Parker SL, Sciubba DM, Bydon A, et al. Trans-foraminal versus posterior lumbar interbody fusion: Comparison of surgical morbidity. Neurol Res 2011;33:38–42.

    Article  PubMed  Google Scholar 

  11. Humphreys SC, Hodges SD, Patwardhan AG, Eck JC, Murphy RB, Covington LA. Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine (Phila Pa 1976) 2001;26:567–71.

    Article  CAS  Google Scholar 

  12. Park J, Kim Y, Hong H, Hwang S. Comparison between posterior and transforaminal approaches for lumbar interbody fusion. J Korean Neurosurg Soc 2005;37:340–4.

    Google Scholar 

  13. Meyerding HW. Spondylolisthesis. Surg Gynecol Obstet 1932;54:371–80.

    Google Scholar 

  14. Guyatt GH, Townsend M, Berman LB, Keller JL. A comparison of Likert and visual analogue scales for measuring change in function. J Chronic Dis 1987;40:1129–33.

    Article  CAS  PubMed  Google Scholar 

  15. Walsh TL, Hanscom B, Lurie JD, Weinstein JN. Is a condition-specific instrument for patients with low back pain/leg symptoms really necessary? The responsiveness of the Oswestry Disability Index, MODEMS, and the SF-36. Spine (Phila Pa 1976) 2003;28:607–15.

    Google Scholar 

  16. Brantigan JW, Steffee AD, Lewis ML, Quinn LM, Persenaire JM. Lumbar interbody fusion using the Brantigan I/F cage for posterior lumbar interbody fusion and the variable pedicle screw placement system: Two-year results from a food and drug administration investigational device exemption clinical trial. Spine (Phila Pa 1976) 2000;25:1437–46.

    Article  CAS  Google Scholar 

  17. Hackenberg L, Halm H, Bullmann V, Vieth V, Schneider M, Liljenqvist U. Transforaminal lumbar interbody fusion: A safe technique with satisfactory three to five year results. Eur Spine J 2005;14:551–8.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Tang S, Xu W. Does disc space height of fused segment affect adjacent disc degeneration in anterior lumbar interbody fusion? A radiological study. Iran Red Crescent Med J 2012;14:139–45.

    PubMed  PubMed Central  Google Scholar 

  19. Siambanes D, Mather S. Comparison of plain radiographs and CT scans in instrumented posterior interbody fusion. Orthopedics 1998;21:165–7.

    CAS  PubMed  Google Scholar 

  20. Macnab I. Negative disc exploration. J Bone Joint Surg 1971;53:891–901.

    Article  CAS  PubMed  Google Scholar 

  21. Fujiwara A, Tamai K, An HS, Kurihashi T, Lim TH, Yoshida H, et al. The relationship between disc degeneration, facet joint osteoarthritis, and stability of the degenerative lumbar spine. J Spinal Disord 2000;13:444–50.

    Article  CAS  PubMed  Google Scholar 

  22. O’Sullivan PB. Lumbar segmental “instability”: Clinical presentation and specific stabilizing exercise management. Man Ther 2000;5:2–12.

    Article  PubMed  Google Scholar 

  23. Kraft CN, Krauspe R. Spondylolisthesis. In: Boos N, Aebi M, editors. Spinal Disorders: Fundamentals of Diagnosis and Treatment. Berlin: Springer; 2008. p. 733–96.

    Chapter  Google Scholar 

  24. Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol. 2003;13:371–9.

    Article  PubMed  Google Scholar 

  25. Lund T, Oxland TR, Jost B, Cripton P, Grassmann S, Etter SC, et al. Interbody cage stabilisation in the lumbar spine biomechanical evaluation of cage design, posterior instrumentation and bone density. J Bone Joint Surg Br 1998;80-B: 351–9.

    Article  Google Scholar 

  26. Yan D, Pei F, Li J, Soo C. Comparative study of PILF and TLIF treatment in adult degenerative spondylolisthesis. Eur Spine J 2008;17:1311–6.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Dvorak J, Panjabi MM, Chang DG, Theiler R, Grob D. Functional radiographic diagnosis of the lumbar spine: Flexion-extension and lateral bending. Spine (Phila Pa 1976) 1991;16:562–71.

    Article  CAS  Google Scholar 

  28. Jang S, Kong M, Hymanson HJ, Jin TK, Song KY, Jeffrey C, et al. Radiographic parameters of segmental instability in lumbar spine using kinetic MRI. J Korean Neurosurg Soc 2009;45:24–31.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lang P, Chafetz N, Genant HK, Morris JM. Lumbar spinal fusion. Assessment of functional stability with magnetic resonance imaging. Spine (Phila Pa 1976) 1990;15:581–8.

    Article  CAS  Google Scholar 

  30. Audat Z, Moutasem O, Yousef K, Mohammad B. Comparison of clinical and radiological reslts of posterolateral fusion, posteror lumbar interbody fusion and transforaminal lumbar interbody fusion techniques in the treatment of degenerative lumbar spine. Singapore Med J 2012;53:183–7.

    CAS  PubMed  Google Scholar 

  31. Hsieh PC, Koski TR, O’shaughnessy BA, Sugrue P, Salehi S, Ondra S, et al. Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: Implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine 2007;7:379–86.

    Article  PubMed  Google Scholar 

  32. Osman SG, Nibu K, Panjabi MM, Marsolais EB, Chaudhary R. Transforaminal and posterior decompressions of the lumbar spine. A comparative study of stability and intervertebral foramen area. Spine (Phila Pa 1976) 1997;22:1690–5.

    Article  CAS  Google Scholar 

  33. Rahn KA, Shugart RM, Wylie MW, Reddy KK, Morgan JA. The effect of lordosis, disc height change, subsidence, and transitional segment on stand-alone anterior lumbar interbody fusion using a nontapered threaded device. Am J Orthop 2010;39:E124–9.

    PubMed  Google Scholar 

  34. Kim M, Chung H, Kim D, Kim S, Jeon S. The clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody single level fusion. Asian Spine J 2011;5:111–6.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Klemme WR, Owens BD, Dhawan A, Zeidman S, Pollv DW Jr. Lumbar sagittal contour after posterior inter-body fusion: Threaded devices alone versus vertical cages plus posterior instrumentation. Spine (Phila Pa 1976) 2001;26:534–7.

    Article  CAS  Google Scholar 

  36. Kim S, Jeon T, Heo Y, Lee W, Yi J, Kim T, et al. Radiographic results of single level transforaminal lumbar interbody fusion in degenerative lumbar spine disease: Focusing on changes of segmental lordosis in fusion segment. Clin Orthop Surg 2009;1:207–13.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Djurasovic MO, Carreon LY, Glassman SD, Dimar JR 2nd, Puno RM, Johnson JR. Sagittal alignment as a risk factor for adjacent level degeneration: A case-control study. Orthopedics 2008;31:546.

    Article  PubMed  Google Scholar 

  38. Gelb DE, Lenke LG, Bridwell KH, Blanke K, McEnery KW. An analysis of saggital spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine (Phila Pa 1976) 1995;20:1351–8.

    Article  CAS  Google Scholar 

  39. Jeon JH, Kim SM, Jung DJ, Moon SM, Hwang HS, Choi SK. PLIF using cages at the instability level and additional transpedicular instrumental fusion in multilevel degenerative lumbar disease. J Korean Neurosurg Soc 2004;35:372–8.

    Google Scholar 

  40. Kuslich SD, Danielson G, Dowdle JD, Sherman J, Fredrickson B, Yuan H, et al. Four-year followup results of lumbar spine arthrodesis using the Bagby and Kuslich lumbar fusion cage. Spine (Phila Pa 1976) 2000;25:2656–62.

    Article  CAS  Google Scholar 

  41. Chastain CA, Eck JC, Hodges SD, Humphreys SC, Levi P. Transforaminallumbar interbody fusion: A retrospective study of long term pain relief and fusion outcomes. Orthopedics 2007;30:389–92.

    Article  PubMed  Google Scholar 

  42. Kim KS, Yang TK, Lee JC. Radiological changes in the bone fusion site after posterior lumbar interbody fusion using carbon cages impacted with laminar bone chips: Followup study over more than 4 years. Spine (Phila Pa 1976) 2005;30:655–60.

    Article  Google Scholar 

  43. Brodke DS, Dick JC, Kunz DN, McCabe R, Zdeblick TA. Posterior lumbar interbody fusion. A biomechanical comparison, including a new threaded cage. Spine (Phila Pa 1976) 1997;22:26–31.

    Article  CAS  Google Scholar 

  44. Tsantrzos A, Baramki HG, Zeidman S, Steffen T. Segmental stability and compressive strength of posterior lumbar interbody fusion implants. Spine (Phila Pa 1976) 2000;25:1899–907.

    Article  Google Scholar 

  45. Kumar A, Kozak JA, Doherty BJ, Dickson JH. Interspace distraction and graft subsidence after anterior lumbar fusion with femoral strut allograft. Spine (Phila Pa 1976) 1993;18:2393–400.

    Article  CAS  Google Scholar 

  46. Steinmann JC, Herkowitz HN. Pseudarthrosis of the spine. Clin Orthop 1992;284:80–90.

    Google Scholar 

  47. Thalgott JS, LaRocca H, Aebi M, Dwyer AP, Razza BE. Reconstruction of the lumbar spine using AO DCP plate internal fixation. Spine (Phila Pa 1976) 1989;14:91–5.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh

    Kamrul Ahsan

  2. Department of Orthopaedic Surgery, Room No 605, Islami Bank Central Hospital, 30, Anjuman Mufdul Islam Road, Kakrail, Dhaka, 1000, Bangladesh

    Najmus SakebP

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  1. Najmus SakebP
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Correspondence to Najmus SakebP.

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SakebP, N., Ahsan, K. Comparison of the early results of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in symptomatic lumbar instability. IJOO 47, 255–263 (2013). https://doi.org/10.4103/0019-5413.111484

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