Comparative study of three surgical procedures of lumbar interbody fusion for adult low-grade isthmic spondylolisthesis / 中华骨科杂志

ABSTRACT

Objective To compare the clinical and radiographic outcomes of 3 kinds of lumbar interbody fusion (ALIF,PLIF,TLIF) for adult low-grade isthmic spondylolisthesis at L4.5 and L5S1 levels.Methods Data of seventy patients with lowgrade isthmic spondylolisthesis who had undergone different lumbar interbody fusion (LIF) procedures according to the assessment of the clinical manifestation,neurological symptoms,plane of the common iliac vessels and the width of vascular window by three-dimensional computed tomography angiography between May 2004 and May 2014 were retrospectively reviewed.21 patients had undergone anterior LIF (ALIF)(13 males and 8 females with an average of 43.29±8.15 years old (range,29-53 years old);L4,5 in ten,L5S1 in 11;Meyerding grade Ⅰ 10 cases,grade Ⅱ 11 cases);25 patients had undergone posterior LIF (PLIF) (12 males and 13 females,with an average of 44.04±12.71 years old (range,25-64 years old);L4.5 in 12,L5S1 in 13;Meyerding grade Ⅰ 15 cases,grade Ⅱ 10 cases) and 24 patients had undergone transforaminal LIF (TLIF) (12 males and 12 females with an average of 45.00± 9.36 years old (range,34-62 years old);L4,5 in 12,L5S1 in 12;Meyerding grade Ⅰ 11 cases,grade Ⅱ 13 cases).Results All patients were followed up for 24-37 months (average,25.6±8.7 months).The visual analogue scale (VAS) in all groups were decreased from 7.05±0.87 (ALIF),6.60±1.39 (PLIF),6.75±1.11 (TLIF) pre-operation to 0.90±0.70,0.96±0.68,1.04±0.62 24 months after operation.Oswestry disability index (ODI) scores were decreased from 78.53％±6.25％,79.80％±6.55％,79.92％±8.10％ preoperation to 17.14％±3.01％,21.32％±4.40％,22.46％±3.87％.Perioperative data including operation time,blood loss,postoperative blood drainage,length of stay showed no significant difference between ALIF group and TLIF group,but showing significant difference comparing with PLIF group.The imageological results showed that ALIF procedure increased whole lumbar lordosis (WL) and disc height (DH),showing no significant difference comparing with PLIF group,but showing significant difference comparing with TLIF group.The ALIF procedure increased segmental lordosis angle (SL),showing significant difference comparing with PLIF group and TLIF group.The PLIF procedure decreased spondylolisthesis index (SI),showing significant difference comparing with A/TLIF group,but showing no significant difference between ALIF group and TLIF group.There was no significant difference showed comparing the L1 axis S1 distance (LASD) and sacral slope (SS),in three groups.The graft fusion was achieved in all patients after 6-8 months postoperatively without instrument failure or displacement.Conclusion Three surgical procedures of lumbar interbody fusion for adult low-grade isthmic spondylolisthesis showed silimar clinical efficacy.The ALIF procedure is superior in its capacity to restore WL,DH,and SL,and the P/TLIF procedure are superior in correcting the vertebral slippage and spinal cord decompression.