Yan Deng-lu, Pei Fu-xing, Li Jian, Soo Cheng-long
Orthopedic Department, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, Peoples Republic of China.
Eur Spine J. 2008 Oct;17(10):1311-6. doi: 10.1007/s00586-008-0739-1. Epub 2008 Aug 7.
This study is to compare the therapeutic effect of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) with pedicle screw fixation on treatment in adult degenerative spondylolisthesis. A retrospective analysis of 187 patients to compare the complications and associated predictive factors of the two techniques of one level lumbar fusion. Ninety-one had PLIF with two cages and pedicle fixation (group 1), and ninety-six had TLIF with one cage and pedicle fixation (group 2). The two groups had similar age and sex distribution, and level of pain. Inclusion criteria and outcome measurements were identical in both groups. The two groups were operated on with autograft and cage with pedicle fixation. Before surgery and at the 2-year follow-up, pain (VAS) and functional disability (JOA) were quantified. The results showed there were no intraoperative deaths in our study. In the end 176 cases had 2-year follow-up while 11 cases were lost to follow-up. The follow-up rate was 93.4% (85/91) in the PLIF group and 94.8% (91/96) in the TLIF group. All patients had bone fusion, and there were no cases of cage extrusion. The pain index improved from 7.08 +/- 1.13 to 2.84 +/- 0.89 in PLIF patients and improved from 7.18 +/- 1.09 to 2.84 +/- 0.91 in TLIF patients (P < 0.001). There were 42 cases of excellent, 29 cases of good, 11 cases of general, and 3 cases of poor results in PLIF group. There were 46 cases of excellent, 31 case of good, 12 case of general, and 2 cases of poor results in TLIF group. The JOA score in all patients was 84.1% of good or excellent (83.5% in PLIF and 84.6% in TLIF, P > 0.05). The average preoperative slip was 30.1 +/- 7.2% in PLIF group while in the TLIF it was 31.4 +/- 8.3%. Immediately post operatively it was reduced to 7.3 +/- 2.1% and 7.4 +/- 2.7% and at last F/U it was 8.1 +/- 2.8% and 8.2 +/- 2.6%, respectively. The average of reduction rate was 75.2 +/- 6.4% in PLIF and 75.4 +/- 6.2 in TLIF on the initial post operatively X-ray, and 72.6 +/- 5.2% and 72.4 +/- 5.4% on the follow-up. The percentage rate, reduction rate and lost of reduction rate between the two groups was similar (P > 0.05). The average pre operative disk and foramen height in the PLIF group improved from 6.8 +/- 2.3 and 14.2 +/- 1.7 preoperatively to 11.6 +/- 1.5 and 18.7 +/- 1.8 post operatively, respectively. At last follow up there was minimal lost of correction down to 11.24 +/- 1.2 and 18.1 +/- 1.8, respectively. Similarly in the TLIF group, pre operative disk and foramen height were improved from 6.7 +/- 1.7 and 14.1 +/- 1.8 to 11.4 +/- 1.6 and 18.5 +/- 1.6 immediately post operative. At last follow up minimal lost of correction was noted with average disc height of 11.3 +/- 1.4 and 18.2 +/- 1.7. Both techniques achieve statistical significance in restoration of disc and foraminal (P < 0.01); however, there was no statistical difference between the two techniques. In conclusion, interbody fusion with either a PLIF technique or a TLIF technique provides good outcomes in the treatment of adult degenerative spondylolisthesis. The TLIF procedure is simpler and is as safe and effective as the PLIF technique.
本研究旨在比较后路腰椎椎间融合术（PLIF）和经椎间孔腰椎椎间融合术（TLIF）联合椎弓根螺钉内固定治疗成人退变性腰椎滑脱症的疗效。回顾性分析187例患者，比较单节段腰椎融合两种技术的并发症及相关预测因素。91例行PLIF，使用两个椎间融合器及椎弓根固定（第1组），96例行TLIF，使用一个椎间融合器及椎弓根固定（第2组）。两组年龄、性别分布及疼痛程度相似。两组纳入标准及结果测量相同。两组均采用自体骨移植、椎间融合器及椎弓根固定进行手术。术前及术后2年随访时，对疼痛（视觉模拟评分法，VAS）和功能障碍（日本骨科学会评分法，JOA）进行量化。结果显示，本研究中无术中死亡病例。最终176例患者获得2年随访，11例失访。PLIF组随访率为93.4%（85/91），TLIF组随访率为94.8%（91/96）。所有患者均获得骨融合，无椎间融合器脱出病例。PLIF患者疼痛指数从7.08±1.13改善至2.84±0.89，TLIF患者疼痛指数从7.18±1.09改善至2.84±0.91（P<0.001）。PLIF组优42例，良29例，可11例，差3例。TLIF组优46例，良31例，可12例，差2例。所有患者JOA评分优良率为84.1%（PLIF组为83.5%，TLIF组为84.6%，P>0.05）。PLIF组术前平均滑脱率为30.1±7.2%，TLIF组为31.4±8.3%。术后即刻分别降至7.3±2.1%和7.4±2.7%，末次随访时分别为8.1±2.8%和8.2±2.6%。术后初期X线片上PLIF组平均复位率为75.2±6.4%，TLIF组为75.4±6.2%，随访时分别为72.6±5.2%和72.4±5.4%。两组间的百分比复位率、复位率及复位丢失率相似（P>0.05）。PLIF组术前椎间盘及椎间孔高度分别为6.8±2.3和14.2±1.7，术后分别改善至11.6±1.5和18.7±1.8。末次随访时矫正丢失最小，分别降至11.24±1.2和18.1±1.8。同样，TLIF组术前椎间盘及椎间孔高度分别为6.7±1.7和14.1±1.8，术后即刻改善至11.4±1.6和18.5±1.6。末次随访时矫正丢失最小记录为平均椎间盘高度11.3±1.4和18.2±1.7。两种技术在恢复椎间盘及椎间孔方面均具有统计学意义（P<0.01）；然而，两种技术之间无统计学差异。总之，PLIF技术或TLIF技术的椎间融合术在治疗成人退变性腰椎滑脱症方面均能取得良好疗效。TLIF手术操作更简单，与PLIF技术一样安全有效。
