Treatment of Adult Spondylolisthesis: PLIF versus PLF: Comparitive Study of Early Functional Outcome

Objective: Aim of this study is to assess and compare the early functional outcomes and results of posterior lumbar interbody fusion (PLIF), and posterolateral fusion (PLF) in the surgical treatment of adult spondylolisthesis.

Background: Posterolateral fusion has been considered the best method for surgical treatment of adult spondylolisthesis. This technique had been widely used. Superior results have subsequently been reported with interbody fusion with cages and posterior instrumentation. In axial loading pull out strength and eccentric loading remains a disadvantage for PLF. The problems such as axial pain, loss of reduction, loosening or failure of fixation materials occurred relatively frequently after posterolateral fusion could be improved by an operation that fused vertebral bodies.

Materials and Methods: Fourty two patients with lumbar spondylolisthesis were operated with moderate to severe low back pain and/or sciatica. Patients with neurogenic claudication also were included. Randomisation technique was followed to allot patients into two different groups according to the mode of bony fusion into PLIF and PLF groups. Both groups were statistically identical.

Results: PLIF and PLF groups had no major differences in blood loss, short-term postoperative clinical result, or complications. Surgical time was slightly prolonged in PLIF when compared to PLF. Visual analog scale for back pain and leg pain, the Oswestry disability index, and fusion rates were significantly better in PLIF. The lumbar lordosis and the segmental angle revealed greater improvement in the PLIF group.

Conclusion: PLIF seems to be a better bone fusion technique than PLF in the management of lumbar spondylolisthesis. The problems encountered in PLF technique have been improved in PLIF.


Sakthivel RN, Balakrishnan V

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