Meta-analysis of instrumented posterior interbody fusion versus instrumented posterolateral fusion in the lumbar spine

A review

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Object

The authors compared the effectiveness of instrumented posterior lumbar interbody fusion (iPLIF) and instrumented posterolateral fusion (iPLF) for the treatment of low-back pain (LBP) due to degenerative lumbar disease.

Methods

Relevant randomized controlled trials (RCTs) and comparative observational studies through December 2009 were identified using a retrieval strategy of sensitive and specific searches. The study design, participant characteristics, interventions, follow-up rate and period, and outcomes were abstracted after the assessment of methodological quality of the trials. Analyses were performed following the method guidelines of the Cochrane Back Review Group.

Results

Nine studies were identified—3 RCTs and 6 comparative observational studies. No significant difference was found between the 2 fusion procedures in the global assessment of clinical outcome (OR 1.51, 95% CI 0.71–3.22, p = 0.29) and complication rate (OR 0.55, 95% CI 0.16–1.86, p = 0.34). Both techniques were effective in reducing pain and improving functional disability, as well as restoring intervertebral disc height. Instrumented PLIF was more effective in achieving solid fusion (OR 2.60, 95% CI 1.35–5.00, p = 0.004), a lower reoperation rate (OR 0.20, 95% CI 0.03–1.29, p = 0.09), and better restoration of segmental angle and lumbar lordotic angle than iPLF. There were no significant differences between the fusion methods regarding blood loss (weighted mean difference –179.63, 95% CI –516.42 to 157.15, p = 0.30), and operating time (weighted mean difference 8.03, 95% CI –45.46 to 61.53, p = 0.77).

Conclusions

The authors' analysis provided moderate-quality evidence that iPLIF has the advantages of higher fusion rate and better restoration of spinal alignment over iPLF. No significant differences were identified between iPLIF and iPLF concerning clinical outcome, complication rate, operating time, and blood loss.

Abbreviations used in this paper: iPLF = instrumented posterolateral fusion; iPLIF = instrumented posterior lumbar interbody fusion; LBP = low-back pain; RCT = randomized controlled trial.

Article Information

Address correspondence to: Shun-Wu Fan, M.D., Ph.D., Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, People's Republic of China. email: zjzhoufrank@gmail.com.

Please include this information when citing this paper: published online May 27, 2011; DOI: 10.3171/2011.4.SPINE10330.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Flowchart of the literature searches for eligible articles.

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    Clinical outcomes of iPLIF versus iPLF for the treatment of degenerative lumbar diseases. M-H = Mantel-Haenszel method.

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    Reduction of back pain of iPLIF versus iPLF for the treatment of degenerative lumbar diseases.

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    Reduction of leg pain of iPLIF versus iPLF for the treatment of degenerative lumbar diseases.

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    Complication rate of iPLIF versus iPLF for the treatment of degenerative lumbar diseases.

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    Fusion rate of iPLIF versus iPLF for the treatment of degenerative lumbar diseases.

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    Reoperation rate of iPLIF versus iPLF for the treatment of degenerative lumbar diseases.

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    Blood loss of iPLIF versus iPLF for the treatment of degenerative lumbar diseases. IV = inverse variance.

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    Operating time of iPLIF versus iPLF for the treatment of degenerative lumbar diseases.

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