Comparison of clinical and radiological results of posterolateral fusion, posterior lumbar interbody fusion and transforaminal lumbar interbody fusion techniques in the treatment of degenerative lumbar spine

Audat Z, Moutasem O, Yousef K, Mohammad B
Correspondence: Dr Audat Ziad, ziadaudat@yahoo.com

ABSTRACT
Introduction Lower back pain due to degenerative disc disease is a common problem that requires surgical treatment, such as posterolateral fusion and posterior instrumentation (PLF), posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF). This retrospective study aimed to compare the clinical and radiological outcomes of these techniques.
Methods 81 patients were treated between 2003 and 2006. The patients were divided into three groups: Group I (PLF n = 17 [43 levels]); Group II (PLIF n = 27 [52 levels]); and Group III (TLIF n = 37 [70 levels]). All patients underwent the same pre- and postoperative clinical and radiological evaluations (using Oswestry Disability Index [ODI], Stanford score and local criteria). Follow-ups were performed at three months and yearly for three years.
Results There was no significant difference in the rates of intra-operative complications (Group I: 17.6%; Group II: 11.1%; Group III: 18.9%; p = 0.688) and postoperative complications (Group I: 11.8%; Group II: 25.9%; Group III: 13.5%; p = 0.343) among the groups. There was a significant decrease in the ODI scores over time (p < 0.005) but no significant difference among the groups at different follow-up times. Radiographic fusion rates for Groups I, II and III were 88%, 88.9% and 91.9%, respectively.
Conclusion Surgical techniques such as PLF, PLIF and TLIF are equally suitable for treating degenerative disc disease, with no differences observed in complications and clinical outcomes. However, in our study, the best radiological outcome was found in patients treated with TLIF.

Keywords: degenerative, fusion, lumbar interbody, posterolateral, transforaminal
Singapore Med J 2012; 53(3): 183–187