Posterior lumbar interbody fusion with instrumented posterolateral fusion in adult spondylolisthesis: description and association of clinico-surgical variables with prognosis in a series of 36 cases

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
Fig. 1
Case 15. A 41 year old man with Grade II degenerative spondylolisthesis, Level L3-L4. (a), the preoperative sagittal T2-weighted MRI illustrates the spondylolisthesis and the retropulsion of the intervertebral disc. (b), the 48-72 h postoperative sagittal radiograph shows PLIF+IPLF, with restoration of the disc space height and improvement of the spondylolisthesis.
Download figure
Open in new tab
Download powerpoint
Fig. 2
Case 36. A 46 years old man with Grade II isthmic spondylolisthesis, Level L4-L5. (a), the preoperative sagittal CT shows the pathology. (b), the 48-72 h postoperative sagittal radiograph illustrates the construction in an adequate position. PLF+IPLF with six screws were employed.

Table 1

Descriptive profiles of patients and pathology.

	Isthmic Spondylolisthesis²	Degenerative Spondylolisthesis²	Total
A) Patient
Age (years)
Mean	44.1	64.2	57.1
Median	46	68	56.5
Range	30 – 75	40 – 82	30 – 82
Gender (No. patients (%))
Men	9 (25 %)	5 (13.9 %)	14 (38.9 %)
Women	6 (16.6 %)	16 (44.5 %)	22 (61.1 %)
Sintomatology (No. patients (%))
None	0 (0 %)	0 (0 %)	0 (0 %)
Back Pain	0 (0 %)	0 (0 %)	0 (0 %)
Sciatica	1 (2.7 %)	5 (13.9 %)	6 (16.6 %)
Neurogenic Claudication	0 (0 %)	0 (0 %)	0 (0 %)
Back pain & Sciatica	6 (16.6 %)	8 (22.1 %)	14 (38.8 %)
Back pain & Sciatica & N.Claudication	9 (25%)	7 (19.4)	16 (44.4 %)
Signs(No. patients (%))
None	4 (11.1 %)	4 (11.1 %)	8 (22.2 %)
Motor	9 (25%)	7 (19.4)	16 (44.4 %)
Sensory	1 (2.7 %)	4 (11.1 %)	5 (13.8 %)
Motor & Sensory	2 (5.5 %)	5 (13.9 %)	7 (19.4 %)
Duration of Symptoms (years)	5.4 ± 4.2	6.7 ± 4.8	6.2 ± 4.6
B) Pathology
Types (No. patients (%))
Isthmic	15 (41.6 %)	----	15 (41.6 %)
Degenerative	----	21 (58.3 %)	21 (58.3 %)
Surgery Levels (No. patients (%))
One	15	19	34 (94.4 %)
Two	0 (0 %)	2 (5.5 %)	2 (5.5 %)
Grades ⁸ (No. levels (%))
I	4 (10.5%)	18 (47.3%)	22 (57.8 %)
II	10 (26.3%)	4 (10.5%)	14 (36.8 %)
III	1 (2.6 %)	1 (2.6 %)	2 (5.2 %)
IV	0 (0 %)	0 (0 %)	0 (0 %)
V	0 (0 %)	0 (0 %)	0 (0 %)
Levels (No. levels (%))
L3-L4	0 (0 %)	3 (7.8 %)	3 (7.8 %)
L4-L5	5 (13.2 %)	14 (36.8 %)	19 (50 %)
L5-S1	10 (26.3 %)	6 (15.7 %)	16 (42.1 %)
Previous discectomy (No. patients (%))
Yes	0 (0 %)	5 (13.9 %)	5 (13.8 %)
No	15 (41.8 %)	16 (44.4 %)	31 (86.2 %)

Table 2

Pain scores and improvement at follow-up.

	VAS^* (χ² ± SD)	Improvement (%)	Student′s T	p^*
Lumbar pain
Preoperatory	7.7 ± 0.6	--	--	--
3 months postop	1.3 ± 0.4	82.8	43.8	p < 0.01
6 months postop	1.3 ± 0.4	82.1	54.2	p < 0.01
1 year postop	1.5 ± 0.5	79.6	62.7	p < 0.01
Leg pain
Preoperatory	6.5 ± 0.6	--	--	--
3 months postop	0.5 ± 0.5	91.0	54.0	p < 0.01
6 months postop	0.6 ± 0.6	90.5	47.2	p < 0.01
1 year postop	0.9 ± 0.9	86.3	36.0	p < 0.01

↵* Pain was measured on a 10-point VAS.
** Paired Student's T-test was used to calculate the differences between the preoperatory and postoperatory periods. Significant differences were found (p < 0.01).

Table 4

Radiological Results after 1 year of follow up.

	Isthmic Spondylolisthesis (No. levels (%))	Degenerative Spondylolisthesis (No. levels (%))	Total (No. levels (%))
PLIF (Brantigan et al ¹¹)
Level 5	15/15 (100%)	21/23 (91.3%)	36/38 (94.7%)
Level 4	0/15 (0%)	2/23 (8.7%)	2/38 (5.3%)
Level 3	0/15 (0%)	0/23 (0%)	0 (0%)
Level 2	0/15 (0%)	0/23 (0%)	0 (0%)
Level 1	0/15 (0%)	0/23 (0%)	0 (0%)
IPLF (Lenke et al ¹²)
Grade A	14/15 (93.3%)	20/23 (87%)	34/38 (89.4%)
Grade B	1/15 (6.7%)	3/23 (13%)	4/38 (10.6%)
Grade C	0/15 (0%)	0/23 (0%)	0 (0%)
Grade D	0/15 (0%)	0/23 (0%)	0 (0%)

Table 5

Comparison between the more relevant series in the literature^* and present study.

	Study design	Patients (No.)	Mean Age (Years)	Gender (Women/ Men)	Type of Spondylolisthesis	Surgical Technique	Mean Follow up (Years)	Total Follow up Rate (%)	Clinical Satisfaction (No.patients (%))	Fusion Rate (No.patients (%))	Major Complications^**(No.patients (%))
Ekman et al.⁴⁵	Prospective	86	40	53/33	Isthmic	PLIF +PLF	2	98%	74/86 (86%)	---	12/86 (13.9%)
Periasamy et al.⁶²	Retrospective	75	48.7	30/45	Isthmic+Degen-erative	PLIF +PLF	2.4	---	64/75 (85.3%)	71/75 (94.6%)	10/75 (13.3%)
Abdu et al.⁶³	Prospective	63	59.7	50/13	Degenerative	PLIF +PLF	4	73%	---	47/54 (87%)	9/63 (14.2%)
Kim et al.⁴⁷	Prospective	48	53.4	35/13	Isthmic+Degen-erative	PLIF +PLF	3	---	41/48 (85.4%)	46/48 (96%)	3/48 (6.2%)
Suck et al.⁴³	Retrospective	36	---	---	Isthmic	PLIF +PLF	3.3	100%	35/36 (97%)	36/36 (100%)	2/36 (5.5%)
Cuningham et al. ⁵⁴	Prospective	31	43	17/14	Isthmic	PLIF +PLF	6.33	77%	---	---	---
Madam et al.⁴⁴	Retrospective	23	41.1	9/14	Isthmic	PLIF +PLF	2.4	100%	23/23 (100%)	23/23 (100%)	2/23 (8.6%)
Wang et al.⁵⁰	Retrospective	21	52.7	---	Isthmic+Degen-erative	PLIF +PLF	1	100%	19/21 (90%)	---	4/21 (19%)
La Rosa et al.⁵⁶	Prospective	17	57.2	---	Isthmic	PLIF +PLF	2	100%	15/17 (88.2%)	17/17 (100%)	---
Present Study	Prospective	36	57.1	22/14	Isthmic+Degen-erative	PLIF +PLF	1	100%	34/36 (94.5%)	33/36 (91.6%)	5/36 (13.8%)

↵* ^43–45,⁴⁷,⁵⁰,⁵⁴,⁵⁶,⁶³ are comparative studies between two or more surgical techniques. Only are shown PLIF+PLF Groups.
↵** Major complications: wound haematoma, wound infection, cerebrospinal fluid fistula, permanent or transient leg pain, deep vein thrombosis, pulmonary embolus.