Pooswamy Shanmugasundaram, Muralidharagopalan Niranjanan Raghavn, Subbaiah Sivasubramaniam
Department of Orthopaedics, Saveetha Medical College, Chennai, Tamil Nadu, India.
Indian J Orthop. 2017 Mar-Apr;51(2):131-138. doi: 10.4103/0019-5413.201703.
Spondylolisthesis refers to slippage of one vertebra over the other, which may be caused by a variety of reasons such as degenerative, trauma, and isthmic. Surgical management forms the mainstay of treatment to prevent further slip and worsening. However, there is no consensus regarding the best surgical option to treat these patients. This study compares TLIF and instrumented PLF in patients with Grade I and II spondylolisthesis and analysis the outcome with respect to functional outcome, pain, fusion rate, adequacy of medial facetectomy for decompression, and complications.
Forty patients operated for spondylolisthesis by instrumented posterolateral or transforaminal fusion between January 1, 2010, and June 30, 2012 were included in this retrospective study. They were followed up for 3 years. Twenty one cases were of instrumented posterolateral fusion (PLF) and 19 cases were of transforaminal lumbar interbody fusion (TLIF). The patients were asked to fill up the Oswestry disability index (ODI), Dallas Pain Questionnaire (DPQ), and low back pain rating scale (LBPRS) preoperatively, at 1-month postoperatively, and at 6, 12, 24, and 36 months postoperatively. Radiological parameters were assessed using radiographs.
No significant differences were found in DPQ, LBPRS, or ODI scores preoperative, 1-month postoperative, and at 6, 12, 24 and 36 months followup. No significant difference was found between the two groups in blood loss. The only significant difference between the two groups was in the operative time, in which the instrumented PLF group had a mean of 50 min lesser than the TLIF group ( = 0.02).
TLIF and instrumented PLF are equally efficacious options in the treatment of Grade I and II spondylolisthesis, except lytic type.
椎体滑脱是指一个椎体相对于另一个椎体的滑移，其可能由多种原因引起，如退变、创伤和峡部裂。手术治疗是预防进一步滑移和病情恶化的主要治疗方法。然而，对于治疗这些患者的最佳手术方案尚无共识。本研究比较了I度和II度椎体滑脱患者的经椎间孔腰椎椎体间融合术（TLIF）和器械辅助后路腰椎融合术（PLF），并分析了其功能结局、疼痛、融合率、内侧小关节切除减压的充分性及并发症方面的结果。
本回顾性研究纳入了2010年1月1日至2012年6月30日期间接受器械辅助后外侧或经椎间孔融合术治疗椎体滑脱的40例患者。对他们进行了3年的随访。21例为器械辅助后路融合术（PLF），19例为经椎间孔腰椎椎体间融合术（TLIF）。要求患者在术前、术后1个月以及术后6、12、24和36个月填写奥斯威斯残疾指数（ODI）、达拉斯疼痛问卷（DPQ）和下腰痛评分量表（LBPRS）。使用X线片评估放射学参数。
术前、术后1个月以及术后6、12、24和36个月随访时，DPQ、LBPRS或ODI评分在两组间均未发现显著差异。两组间失血量无显著差异。两组间唯一的显著差异在于手术时间，器械辅助PLF组的平均手术时间比TLIF组少50分钟（P = 0.02）。
TLIF和器械辅助PLF在治疗I度和II度椎体滑脱（溶骨型除外）方面是同样有效的选择。
