Evaluation of Transforaminal Lumbar Interbody Fusion Versus Posterior Lumbar Interbody Fusion in Patients of Lumbar Instability Submitted to Transpedicular Screws Fixation
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- Category: Vol. 80, March 2012
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Evaluation of Transforaminal Lumbar Interbody Fusion Versus Posterior Lumbar Interbody Fusion in Patients of Lumbar Instability Submitted to Transpedicular Screws Fixation, ABDELAZEEM A. ELSAYED, MOHAMED Y. ELQAZAZ, KHALED E. MOHAMED and MOHAMED S.
SHATER
Abstract
Purpose: This study is conducted to compare the surgical results of Posterior Lumbar Interbody Fusion (PLIF) and Transforaminal Lumbar Interbody Fusion (TLIF), with pedicle screw fixation, in the treatment of patients with lumbar instability.
Patients and Methods: A prospective study of 21 patients to compare the clinical and radiological outcomes of the two techniques. Eleven patients had been operated with the PLIF technique with two cages (carbon fiber) and pedicle fixation (group 1), and ten patients had been operated with the TLIF technique with one cage (carbon fiber) and pedicle fixation (group 2). We included patients between 18-65 years, with lumbar instability, without previous lumbar surgery, grades 1 and 2 spondylolisthesis. Patients with previous lumbar surgery or with higher grades 3 and 4 spondylolisthesis were excluded. Visual Analogue Scale (VAS) for pain and Oswestry Disability Index (ODI) were used to assess the patients pre-operative and at post0operative intervals at 1,3 and 6 months. Pre-operative and post-operative images were done using static and dynamic X-rays, computerized tomography, and magnetic resonance imaging.
Results: Clinically, the pain index improved from 7.7±1.1 to 2.6±2.1 after six months of follow up in PLIF group with statistical significance. In TLIF group the pain index improved from 7.5±0.7 to 1.6±0.9 after six months of follow-up with statistical significance. The ODI in PLIF group improved from 60.9±15.9 to 32.8±11.3 after six months of follow-up, in TLIF group the ODI improved from 65.4±11.1 to 30.8±6.3 after six months of follow-up with statistical significance in both groups.
Radiological: 72.7% of patients in PLIF group had good fusion while 80% of patients in TLIF group had good fusion with no statistical significance, and there were no cases of cage extrusion.
Conclusion: Both PLIF and TLIF provide the same good clinical and radiological outcome in management of lumbar instability after short term follow-up of 6 months duration. Operative complication is less in TLIF technique, and risk of dural tear diminished significantly. TLIF can save time more than PLIF.