Ibrahim Mahmoud Fouad, Saeed Fady Samy, El-Morshidy Essam Mohammed, Hassan Khaled Mohammed, Hassan Mohamed Gamal, El-Sharkawi Mohammad, Elnady Belal
Department of Orthopedic and Trauma Surgery, Assiut University Hospitals, Assiut, Egypt.
Global Spine J. 2025 Apr;15(3):1614-1624. doi: 10.1177/21925682241254317. Epub 2024 May 10.
Study DesignRandomized controlled trial.ObjectivesTo compare the effect of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) on sagittal radiographic parameters in patients with low-grade isthmic spondylolisthesis. Additionally, to explore the correlation between changes in these parameters and clinical outcomes.MethodsForty-six consecutive patients with single-level low-grade isthmic spondylolisthesis were initially enrolled. They were randomly assigned to undergo either PLF or PLIF. Patients were followed up for at least 24 months. Radiographic outcomes included pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, sagittal vertical axis, T1 pelvic angle, slip angle, slip degree and disc height. Clinical outcomes were assessed by the Oswestry Disability Index (ODI) and visual analogue scale (VAS).ResultsFour participants were lost to follow-up. Of the remaining 42 patients, 29 were female. The mean age was 40.23 ± 10.25 years in the PLF group and 35.81 ± 10.58 years in the PLIF group. There was a statistically significant greater correction of all radiographic parameters in the PLIF group. The ODI and VAS improved significantly in both groups, with no significant differences between the two groups. Changes in the ODI and VAS were significantly correlated with changes in disc height, slip angle and lumbar lordosis.ConclusionsIn patients with low-grade isthmic spondylolisthesis, PLIF demonstrates superior efficacy compared to PLF in correcting sagittal radiographic parameters. Nevertheless, this distinction does not seem to influence short-term clinical results. Restoring disc height, correcting the slip angle, and reestablishing normal lumbar lordosis are crucial steps in the surgical management of isthmic spondylolisthesis.
研究设计
随机对照试验。
目的
比较后外侧融合术（PLF）和腰椎后路椎间融合术（PLIF）对低度峡部裂型腰椎滑脱症患者矢状位影像学参数的影响。此外，探讨这些参数变化与临床疗效之间的相关性。
方法
最初纳入46例连续的单节段低度峡部裂型腰椎滑脱症患者。他们被随机分配接受PLF或PLIF手术。对患者进行至少24个月的随访。影像学结果包括骨盆入射角、骨盆倾斜角、骶骨倾斜角、腰椎前凸、矢状垂直轴、T1骨盆角、滑移角、滑移程度和椎间盘高度。临床疗效通过Oswestry功能障碍指数（ODI）和视觉模拟评分（VAS）进行评估。
结果
4名参与者失访。在其余42例患者中，29例为女性。PLF组的平均年龄为40.23±10.25岁，PLIF组为35.81±10.58岁。PLIF组所有影像学参数的矫正在统计学上有显著更大幅度。两组的ODI和VAS均显著改善，两组之间无显著差异。ODI和VAS的变化与椎间盘高度、滑移角和腰椎前凸的变化显著相关。
结论
在低度峡部裂型腰椎滑脱症患者中，PLIF在矫正矢状位影像学参数方面显示出比PLF更优的疗效。然而，这种差异似乎并未影响短期临床结果。恢复椎间盘高度、矫正滑移角和重建正常腰椎前凸是峡部裂型腰椎滑脱症手术治疗的关键步骤。
