Cunningham John Edward, Elling Elizabeth Mary, Milton Abul Hasnat, Robertson Peter Alexander
Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand.
J Spinal Disord Tech. 2013 Jul;26(5):260-7. doi: 10.1097/BSD.0b013e3182417103.
Long-term prospective observational cohort study.
The objective of the study was to compare the long-term functional outcomes of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) for the treatment of adult isthmic spondylolisthesis (IS).
PLIF has the theoretical advantage of improving sagittal alignment and providing a larger, more consistent fusion mass in patients with IS compared with PLF. Studies to date though have not shown a clinical difference, with follow-up of 2 years.
An prospective cohort study was performed of a single surgeon's patients with IS treated surgically over a 10-year period. Average follow-up was 7 years and 10 months. Preoperative patient characteristics between the 2 groups were not significantly different. The return rate of the long-term questionnaires was 83%. Outcome measures were the Roland Morris Disability Questionnaire (RMDQ), Low Back Outcome Score (LBOS), Short Form (SF)-12v2, and SF-6D R2.
PLIF provided better short-term and long-term results than PLF. The PLIF group had significantly better LBOS scores in the long term, and nonsignificantly better RMDQ scores. As measured by the RMDQ Minimal Clinically Important Difference set at 4 and 8, the LBOS Minimal Clinically Important Difference set at 7.5 points and by SF-12v2 Physical Component Score, PLIF patients performed better than PLF patients. When analyzing single-level fusions alone, the difference is more pronounced, with Physical Component Score, Mental Component Scores, and SF-6D R2 all being significantly better in the PLIF group rather than the PLF group.
This study strongly supports the use of PLIF to obtain equivalent or superior clinical outcomes compared with PLF for spinal fusion for lumbar IS. Although there are considerable issues when commenting on the results of observational studies, the results of this study are the first to report long-term follow-up beyond 2 years, and further larger long-term randomized studies are suggested.
长期前瞻性观察队列研究。
本研究的目的是比较后外侧融合术（PLF）和后路腰椎椎间融合术（PLIF）治疗成人峡部裂性腰椎滑脱（IS）的长期功能结局。
与PLF相比，PLIF在改善矢状面排列以及为IS患者提供更大、更一致的融合块方面具有理论优势。然而，迄今为止的研究在2年随访中未显示出临床差异。
对一位外科医生在10年期间手术治疗的IS患者进行前瞻性队列研究。平均随访时间为7年10个月。两组患者术前的特征无显著差异。长期问卷的回复率为83%。结局指标包括罗兰·莫里斯残疾问卷（RMDQ）、下腰痛结局评分（LBOS）、简明健康状况调查简表（SF）-12v2和SF-6D R2。
PLIF在短期和长期均比PLF效果更好。PLIF组长期的LBOS评分显著更高，RMDQ评分虽无显著更高但也更优。根据设定的RMDQ最小临床重要差异为4和8、LBOS最小临床重要差异为7.5分以及SF-12v2身体成分评分来衡量，PLIF患者比PLF患者表现更好。单独分析单节段融合时，差异更为明显，PLIF组的身体成分评分、精神成分评分和SF-6D R2均显著优于PLF组。
本研究有力支持在腰椎IS的脊柱融合中，与PLF相比，使用PLIF可获得同等或更好的临床结局。尽管在评论观察性研究结果时存在诸多问题，但本研究结果是首个报告超过2年长期随访的，建议进一步开展更大规模的长期随机研究。
