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An RCT study comparing the clinical and radiological outcomes with the use of PLIF or TLIF after instrumented reduction in adult isthmic spondylolisthesis

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Abstract

Objective

We prospectively compared posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) used in adult isthmic spondylolisthesis (IS) after surgical reduction with pedicle screws.

Methods

Between January 2009 and December 2010, 66 adult patients with single-level IS were randomly assigned to two groups treated using the PLIF technique (PLIF group, n = 34) and the TLIF technique (TLIF group, n = 32). Both groups were followed up for an average of 30.5 months (range 24–48 months). Clinical outcomes were assessed using the visual analog scale (VAS), Oswestry disability index (ODI) and Japanese orthopedic association (JOA) scores. Radiographic outcomes included percentage of vertebral slippage, focal lordosis and disk height. Clinical and radiographic outcomes were compared between the two groups.

Results

The average operative time and blood loss during surgery were significantly more in PLIF group than in TLIF group. Spondylolisthesis, disk height and focal lordosis were significantly improved postoperatively in both groups. There was no obvious difference in clinical outcomes, as assessed using the VAS, ODI and JOA scores, and radiographic outcomes. In PLIF group, there were two cases of neuropathic pain after surgery.

Conclusions

After instrumented reduction of adult IS, either PLIF or TLIF can provide good clinical and radiological outcomes. With a single cage, TLIF was superior to PLIF in terms of surgical time and blood loss, but these differences may not be clinically relevant.

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References

  1. Bartolozzi P, Sandri A, Cassini M, Ricci M (2003) One-stage posterior decompression-stabilization and trans-sacral interbody fusion after partial reduction for severe L5–S1 spondylolisthesis. Spine 28:1135–1141. doi:10.1097/01.BRS.0000067274.38273.5C

    PubMed  Google Scholar 

  2. Goyal N, Wimberley DW, Hyatt A, Zeiller S, Vaccaro AR, Hilibrand AS, Albert TJ (2009) Radiographic and clinical outcomes after instrumented reduction and transforaminal lumbar interbody fusion of mid and high-grade isthmic spondylolisthesis. J Spinal Disord Tech 22:321–327. doi:10.1097/BSD.0b013e318182cdab

    Article  PubMed  Google Scholar 

  3. Sears W (2005) Posterior lumbar interbody fusion for lytic spondylolisthesis: restoration of sagittal balance using insert-and-rotate interbody spacers. Spine J 5:161–169. doi:10.1016/j.spinee.2004.05.256

    Article  PubMed  Google Scholar 

  4. Lian XF, Hou TS, Xu JG, Zeng BF, Zhao J, Liu XK, Yang EZ, Zhao C (2014) Single segment of posterior lumbar interbody fusion for adult isthmic spondylolisthesis: reduction or fusion in situ. Eur Spine J 23:172–179. doi:10.1007/s00586-013-2858-6

    Article  PubMed  PubMed Central  Google Scholar 

  5. Floman Y, Millgram MA, Ashkenazi E, Smorgick Y, Rand N (2008) Instrumented slip reduction and fusion for painful unstable isthmic spondylolisthesis in adults. J Spinal Disord Tech 21:477–483. doi:10.1097/BSD.0b013e31815b1abf

    Article  PubMed  Google Scholar 

  6. Audat ZM, Darwish FT, Al Barbarawi MM, Obaidat MM, Haddad WH, Bashaireh KM, Al-Aboosy IA (2011) Surgical management of low grade isthmic spondylolisthesis; a randomized controlled study of the surgical fixation with and without reduction. Scoliosis 6:14. doi:10.1186/1748-7161-6-14

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mehdian SM, Arun R, Jones A, Cole AA (2005) Reduction of severe adolescent isthmic spondylolisthesis: a new technique. Spine 30:E579–E584

    Article  CAS  PubMed  Google Scholar 

  8. Ruf M, Koch H, Melcher RP, Harms J (2006) Anatomic reduction and monosegmental fusion in high-grade developmental spondylolisthesis. Spine 31:269–274. doi:10.1097/01.brs.0000197204.91891.eb

    Article  PubMed  Google Scholar 

  9. Ekman P, Moller H, Tullberg T, Neumann P, Hedlund R (2007) Posterior lumbar interbody fusion versus posterolateral fusion in adult isthmic spondylolisthesis. Spine 32:2178–2183. doi:10.1097/BRS.0b013e31814b1bd8

    Article  PubMed  Google Scholar 

  10. Luo J, Cao K, Yu T, Li L, Huang S, Gong M, Cao C, Zou X (2015) Comparison of posterior lumbar interbody fusion versus posterolateral fusion for the treatment of isthmic spondylolithesis. J Spinal Disord Tech. doi:10.1097/BSD.0000000000000297

    PubMed  Google Scholar 

  11. Feng Y, Chen L, Gu Y, Zhang ZM, Yang HL, Tang TS (2015) Restoration of the spinopelvic sagittal balance in isthmic spondylolisthesis: posterior lumbar interbody fusion may be better than posterolateral fusion. Spine J 15:1527–1535. doi:10.1016/j.spinee.2015.02.036

    Article  PubMed  Google Scholar 

  12. Cunningham JE, Elling EM, Milton AH, Robertson PA (2013) What is the optimum fusion technique for adult isthmic spondylolisthesis—PLIF or PLF? A long-term prospective cohort comparison study. J Spinal Disord Tech 26:260–267. doi:10.1097/BSD.0b013e3182417103

    Article  PubMed  Google Scholar 

  13. Suh KT, Park WW, Kim SJ, Cho HM, Lee JS, Lee JS (2008) Posterior lumbar interbody fusion for adult isthmic spondylolisthesis: a comparison of fusion with one or two cages. J Bone Jt Surg Br 90:1352–1356. doi:10.1302/0301-620X.90B10.21078

    Article  CAS  Google Scholar 

  14. Okuda S, Miyauchi A, Oda T, Haku T, Yamamoto T, Iwasaki M (2006) Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients. J Neurosurg Spine 4:304–309. doi:10.3171/spi.2006.4.4.304

    Article  PubMed  Google Scholar 

  15. Taillard W (1954) Spondylolisthesis in children and adolescents. Acta Orthop Scand 24:115–144

    Article  CAS  PubMed  Google Scholar 

  16. HW M (1932) Spondylolisthesis. Can Med Assoc J 26:16–18

    Google Scholar 

  17. Cobb J (1948) The detection of beta-radiation by photographic film. Rev Sci Instrum 19:441–447

    Article  CAS  PubMed  Google Scholar 

  18. Kwon BK, Berta S, Daffner SD, Vaccaro AR, Hilibrand AS, Grauer JN, Beiner J, Albert TJ (2003) Radiographic analysis of transforaminal lumbar interbody fusion for the treatment of adult isthmic spondylolisthesis. J Spinal Disord Tech 16:469–476

    Article  PubMed  Google Scholar 

  19. Poussa M, Remes V, Lamberg T, Tervahartiala P, Schlenzka D, Yrjonen T, Osterman K, Seitsalo S, Helenius I (2006) Treatment of severe spondylolisthesis in adolescence with reduction or fusion in situ: long-term clinical, radiologic, and functional outcome. Spine 31:583–590. doi:10.1097/01.brs.0000201401.17944.f7 (discussion 591–582)

    Article  PubMed  Google Scholar 

  20. Cook JA, Hislop J, Altman DG, Fayers P, Briggs AH, Ramsay CR, Norrie JD, Harvey IM, Buckley B, Fergusson D, Ford I, Vale LD, group D (2015) Specifying the target difference in the primary outcome for a randomised controlled trial: guidance for researchers. Trials 16:12. doi:10.1186/s13063-014-0526-8

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ekman P, Moller H, Hedlund R (2005) The long-term effect of posterolateral fusion in adult isthmic spondylolisthesis: a randomized controlled study. Spine J 5:36–44. doi:10.1016/j.spinee.2004.05.249

    Article  PubMed  Google Scholar 

  22. Lian XF, Xu JG, Zeng BF, Liu XK, Li H, Qiu ML, Yang EZ (2014) Continuous irrigation and drainage for early postoperative deep wound infection after posterior instrumented spinal fusion. J Spinal Disord Tech 27:E315–E317. doi:10.1097/BSD.0000000000000122

    Article  PubMed  Google Scholar 

  23. de Loubresse CG, Bon T, Deburge A, Lassale B, Benoit M (1996) Posterolateral fusion for radicular pain in isthmic spondylolisthesis. Clin Orthop Relat Res 323:194–201

    Article  PubMed  Google Scholar 

  24. Sudo H, Oda I, Abumi K, Ito M, Kotani Y, Minami A (2006) Biomechanical study on the effect of five different lumbar reconstruction techniques on adjacent-level intradiscal pressure and lamina strain. J Neurosurg Spine 5:150–155. doi:10.3171/spi.2006.5.2.150

    Article  PubMed  Google Scholar 

  25. Liu X, Wang Y, Qiu G, Weng X, Yu B (2014) A systematic review with meta-analysis of posterior interbody fusion versus posterolateral fusion in lumbar spondylolisthesis. Eur spine J 23:43–56. doi:10.1007/s00586-013-2880-8

    Article  PubMed  PubMed Central  Google Scholar 

  26. Grzegorzewski A, Kumar SJ (2000) In situ posterolateral spine arthrodesis for grades III, IV, and V spondylolisthesis in children and adolescents. J Pediatr Orthop 20:506–511

    CAS  PubMed  Google Scholar 

  27. Spruit M, Pavlov PW, Leitao J, De Kleuver M, Anderson PG, Den Boer F (2002) Posterior reduction and anterior lumbar interbody fusion in symptomatic low-grade adult isthmic spondylolisthesis: short-term radiological and functional outcome. Eur Spine J 11:428–433. doi:10.1007/s00586-002-0400-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Mehdian SH, Arun R (2011) A new three-stage spinal shortening procedure for reduction of severe adolescent isthmic spondylolisthesis: a case series with medium- to long-term follow-up. Spine 36:E705–E711. doi:10.1097/BRS.0b013e3182158c1f

    Article  PubMed  Google Scholar 

  29. Akamaru T, Kawahara N, Tim Yoon S, Minamide A, Su Kim K, Tomita K, Hutton WC (2003) Adjacent segment motion after a simulated lumbar fusion in different sagittal alignments: a biomechanical analysis. Spine 28:1560–1566

    PubMed  Google Scholar 

  30. Shufflebarger HL, Geck MJ (2005) High-grade isthmic dysplastic spondylolisthesis: monosegmental surgical treatment. Spine 30:S42–S48

    Article  PubMed  Google Scholar 

  31. Harris BM, Hilibrand AS, Savas PE, Pellegrino A, Vaccaro AR, Siegler S, Albert TJ (2004) Transforaminal lumbar interbody fusion: the effect of various instrumentation techniques on the flexibility of the lumbar spine. Spine 29:E65–E70

    Article  PubMed  Google Scholar 

  32. Recnik G, Kosak R, Vengust R (2013) Influencing segmental balance in isthmic spondylolisthesis using transforaminal lumbar interbody fusion. J Spinal Disord Tech 26:246–251. doi:10.1097/BSD.0b013e3182416f5c

    Article  PubMed  Google Scholar 

  33. Chrastil J, Patel AA (2012) Complications associated with posterior and transforaminal lumbar interbody fusion. J Am Acad Orthop Surg 20:283–291. doi:10.5435/JAAOS-20-05-283

    Article  PubMed  Google Scholar 

  34. Cole CD, McCall TD, Schmidt MH, Dailey AT (2009) Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches. Curr Rev Musculoskelet Med 2:118–126. doi:10.1007/s12178-009-9053-8

    Article  PubMed  PubMed Central  Google Scholar 

  35. Liu J, Deng H, Long X, Chen X, Xu R, Liu Z (2015) A comparative study of perioperative complications between transforaminal versus posterior lumbar interbody fusion in degenerative lumbar spondylolisthesis. Eur Spine J. doi:10.1007/s00586-015-4086-8

    Google Scholar 

  36. Zhou J, Wang B, Dong J, Li X, Zhou X, Fang T, Lin H (2011) Instrumented transforaminal lumbar interbody fusion with single cage for the treatment of degenerative lumbar disease. Arch Orthop Trauma Surg 131:1239–1245. doi:10.1007/s00402-011-1292-7

    Article  PubMed  Google Scholar 

  37. Hackenberg L, Halm H, Bullmann V, Vieth V, Schneider M, Liljenqvist U (2005) Transforaminal lumbar interbody fusion: a safe technique with satisfactory three to five year results. Eur Spine Journal 14:551–558. doi:10.1007/s00586-004-0830-1

    Article  Google Scholar 

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Acknowledgments

The authors thank Cameron Rawanduzy from Brain and Spine Center of Weill Cornell Medical College for his helpful discussion and contribution for this manuscript.

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Authors and Affiliations

  1. Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China

    Er-Zhu Yang, Jian-Guang Xu, Xiao-Kang Liu, Bing-Fang Zeng & Xiao-Feng Lian

  2. Department of Orthopedics, 101st Hospital of PLA, Wuxi, Jiangsu, China

    Gen-Yang Jin

  3. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Wenzhen Xiao

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  1. Er-Zhu Yang
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Yang, EZ., Xu, JG., Liu, XK. et al. An RCT study comparing the clinical and radiological outcomes with the use of PLIF or TLIF after instrumented reduction in adult isthmic spondylolisthesis. Eur Spine J 25, 1587–1594 (2016). https://doi.org/10.1007/s00586-015-4341-z

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