Adjacent Segment Degeneration after Single-Level PLIF: Comparison between Spondylolytic Spondylolisthesis, Degenerative Spondylolisthesis and Spinal Stenosis

STUDY DESIGN: A retrospective study. PURPOSE: To comparatively investigated the rate of the adjacent segment degeneration and the clinical outcomes in patients with spondylolytic spondylolisthesis, spinal stenosis or degenerative spondylolisthesis. OVERVIEW OF LITERATURE: There have been few studies reported on the adjacent segment degeneration following posterior lumbar interbody fusion(PLIF). Many risk factors for the adjacent segment degeneration following PLIF have been proposed. The range of decompression has been presented as one of the risk factors, yet controversial. METHODS: This study enrolled sixty-three patients who had been treated with single-level PLIF and who were followed up for more than two years. The patients were divided into 3 groups based on the preoperative diagnosis. We analyzed the difference between the preoperative and postoperative intervertebral disc heights of the superior adjacent segments. The incidence rates of instability and the clinical outcomes were comparatively analyzed between each group. RESULTS: The average age of the patients was 55.8 years in the spondylolytic spondylolisthesis group, 65.9 years in the degenerative spondylolisthesis group and 60.4 years in the spinal stenosis group. The average follow-up period was 44 months, 43 months and 42 months, respectively. At the last follow-up, compared to the preoperative period, the intervertebral disc height decreased in all three groups. A statistically significant decrease (p < 0.01) was observed only in the spondylolytic spondylolisthesis group and no significant difference was observed between each group (p = 0.41). The incidence rate of instability and the clinical outcome were not significantly different between each group. CONCLUSIONS: Spondylolytic spondylolisthesis with total laminectomy and single-level PLIF showed no significant difference in the superior adjacent segment degeneration and instability, and the clinical outcome as compared to that of partial laminectomy with single-level PLIF for treating degenerative spondylolisthesis or spinal stenosis.

Comparison between Posterior Lumbar Interbody Fusion with Pedicle Screw Fixation and Posterolateral Fusion with Pedicle Screw Fixation in Spondylolytic Spondylolisthesis in Adults / 대한척추외과학회지

STUDY DESIGN: This was a retrospective study that analyzed and compared the results between a posterior lumbar interbody fusion, and a posterolateral fusion (PLIF+PLF), and PLF alone, in the treatment of spondyolytic spondylolisthesis in adults. OBJECTIVES: To evaluate the outcomes of two surgical treatment methods for spondylolytic spondylolisthesis-posterolateral fusion alone, and circumferential fusion, using posterior lumbar interbody fusion and posterolateral fusion. SUMMARY OF LITERATURE REVIEW: There have been many reports regarding the surgical treatment of spondylolisthesis. Posterior lumbar interbody fusions have certain distinct mechanical advantages over posterolateral ones. However, the clinical and radiological results do not usually correlate. MATERIALS AND METHODS: Between January 1998 and December 2001, 38 patients, with spondylolytic spondylolisthesis, were operated on by a single surgeon. Nineteen patients underwent a posterolateral fusion alone (group I), with the same number undergoing an additional posterior lumbar interbody fusion (group II). These two groups were evaluated for their clinical outcomes, radiological measurements and fusion rates. RESULTS: The losses in the slip reduction were 7.1 and 1.3% in the PLF and PLF+PLIF groups, respectively (P0.05). CONCLUSIONS: Although the addition of a posterior lumbar interbody fusion, to an instrumented posterolateral fusion, following decompression, is more predictable in maintaining a correction and achieving union, a posterolateral fusion may have a better clinical outcome in patients with low grade spondylolytic spondylolisthesis. Therefore, careful patient selection is necessary for each operation.

Comparison between Posterolateral Fusion with Pedicle Screw Fixation and Anterior Interbody Fusion with Pedicle Screw Fixation in Adult Spondylolytic Spondylolisthesis

There have been many reports regarding various operative methods for spondylolytic spondylolisthesis. However, there have been no reports regarding the comparison between posterolateral fusion (PLF) with pedicle screw fixation (PSF) and anterior lumbar interbody fusion (ALIF) with PSF. The purpose of the current study was to compare the clinical outcomes of PLF with PSF and ALIF with PSF, and to help in the selection of treatment options. Fifty-six patients with spondylolytic spondylolisthesis who underwent PLF with PSF (group 1, 35 patients) or who underwent ALIF with PSF (group 2, 21 patients) were studied. Minimum follow-up was 2 years. Demographic variables and disease state were similar for the two groups. We studied operating time, amount of blood loss, duration of hospital stay, clinical outcomes, complications, time at which fusion was complete, fusion rate, and radiological measurements. There were no significant differences between the two groups in terms of the amount of blood loss, duration of hospital stay, back pain, radiating pain, fusion rate, or complication rate. However, in group 2, the operation time and the time at which fusion became complete was longer, and in group 1 there was significant radiological reduction loss. In conclusion, PLF with PSF was just as effective as ALIF with PSF in terms of clinical outcomes, but ALIF with PSF was superior to PLF with PSF in terms of the prevention of reduction loss. Anterior support would be helpful for preventing reduction loss in cases of spondylolytic spondylolisthesis of the lumbar spine.

Comparison between Posterolateral Fusion with Pedicle Screw Fixation and Anterior Interbody Fusion with Pedicle Screw Fixation in Spondylolytic Spondylolisthesis of the Lumbar Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective study was performed in spondylolytic spondylolisthesis patients who had undergone posterolateral fusion with pedicle screw fixation or anterior lumbar interbody fusion with pedicle screw fixation. OBJECTIVES: To compare the clinical outcomes of posterolateral fusion with pedicle screw fixation and anterior lumbar interbody fusion with pedicle screw fixation, and to help in the selection of treatment options. SUMMARY OF LITERATURE REVIEW: There have been many reports regarding 360degree fusion, anterior lumbar interbody fusion, posterolateral fusion, and posterior lumbar interbody fusion with or without instrumentation in spondylolytic spondylolisthesis. However, there has been no reports regarding the comparison between posterolateral fusion with pedicle screw fixation and anterior lumbar interbody fusion with pedicle screw fixation. MATERIALS AND METHODS: Fifty-six patients with spondylolytic spondylolisthesis who underwent posterolateral fusion with pedicle screw fixation(group 1, 35 patients) or who underwent anterior lumbar interbody fusion with pedicle screw fixation(group 2, 21 patients) were studied. Minimum follow-up was 2 years. Demographic variables and disease state were similar between the two groups. We reviewed medical records and radiological films. We studied operating time, amount of blood loss, duration of hospital stay, clinical outcomes, complications, time at which fusion was complete, fusion rate, and radiological measurements. RESULTS: There were no significant differences between the two groups in terms of amount of blood loss, duration of hospital stay, back pain, radiating pain, fusion rate, and complication rate. However, in the group of anterior interbody fusion with pedicle screw fixation, the operation time and the time at which fusion was complete was longer. There was significant radiological reduction loss in group 1. CONCLUSIONS: Posterolateral fusion with pedicle screw fixation was just as effective as anterior interbody fusion with pedicle screw fixation in terms of clinical outcomes, but anterior lumbar interbody fusion with pedicle screw fixation was superior to posterolateral fusion with pedicle screw fixation in terms of prevention of reduction loss. Anterior support would be helpful for the prevention of reduction loss in spondylolytic spondylolisthesis of the lumbar spine.