Posterior Lumbar Interbody Fusion versus Posterolateral Fusion in Surgical Treatment of Lumbar Spondylolithesis

Abstract

Background: The optimal surgical technique for lumbar spondylolithesis remains debated. Although posterior lumbar interbody fusion (PLIF) theoretically offers more advantages than posterolateral lumbar fusion (PLF), the evidence remains inconclusive. Aim: The aim of this study is to compare the clinical and functional outcomes of PLIF versus PLF in patients with lumbar spondylolithesis. Patients and Methods: We enrolled 38 patients with lumbar spondylolithesis (degenerative and isthmic) who underwent PLIF (N = 19) or PLF (N = 19). We collected operative data and performed follow-up for 12 months after the surgery. The collected data were analyzed using the SPSS software to detected significant differences between both groups. Results: The PLF and PLIF groups exhibited similar pre-operative characteristics between both groups in terms of age (p = 0.57), sex (p = 0.73), clinical presentation (p = 1), required levels of fixation (p = 1), pre-operative VAS score (p = 0.43) or muscle weakness (p = 1). However, the PLIF group had significantly more blood loss and longer operative time than the PLF group. Moreover, both groups had similar levels of postoperative pain (up to six months after surgery), and post-operative complications. The rates of arthrodesis were higher in PLIF group than PLF group within six months while no significant difference within 12 months of follow-up. Conclusion: In our comparative study, we achieved comparison between pedicle screw fixation with posterolateral fusion alone (PLF) in compare with pedicle screw fixation with posterior lumbar interbody fusion (PLIF). Results indicate better results of fusion rate in PLIF as regards arthrodesis with slightly more rate of complication than PLF. So we recommend PLIF in cases of lumbar spondylolithesis than PLF.