Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Medical College of Zhejiang University, and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, People's Republic of China
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.
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.
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).
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.
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: firstname.lastname@example.org.
Please include this information when citing this paper: published online May 27, 2011; DOI: 10.3171/2011.4.SPINE10330.
AbduWALurieJDSprattKFTostesonANZhaoWTostesonTD: Degenerative spondylolisthesis: does fusion method influence outcome? Four-year results of the spine patient outcomes research trial. Spine (Phila Pa 1976)34:2351–23602009
Bjarke ChristensenFStender HansenELaursenMThomsenKBüngerCE: Long-term functional outcome of pedicle screw instrumentation as a support for posterolateral spinal fusion: randomized clinical study with a 5-year follow-up. Spine (Phila Pa 1976)27:1269–12772002
ChristensenFBHansenESEiskjaerSPHøyKHelmigPNeumannP: Circumferential lumbar spinal fusion with Brantigan cage versus posterolateral fusion with titanium Cotrel-Dubousset instrumentation: a prospective, randomized clinical study of 146 patients. Spine (Phila Pa 1976)27:2674–26832002
CunninghamBWKotaniYMcNultyPSCappuccinoAMcAfeePC: The effect of spinal destabilization and instrumentation on lumbar intradiscal pressure: an in vitro biomechanical analysis. Spine (Phila Pa 1976)22:2655–26631997
DantasFLPrandiniMNFerreiraMA: Comparison between posterior lumbar fusion with pedicle screws and posterior lumbar interbody fusion with pedicle screws in adult spondylolisthesis. Arq Neuropsiquiatr65:3B764–7702007
DehouxEFouratiEMadiKReddyBSegalP: Posterolateral versus interbody fusion in isthmic spondylolisthesis: functional results in 52 cases with a minimum follow-up of 6 years. Acta Orthop Belg70:578–5822004
FischgrundJSMackayMHerkowitzHNBrowerRMontgomeryDMKurzLT: 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine (Phila Pa 1976)22:2807–28121997
FritzellPHäggONordwallA: Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group. Eur Spine J12:178–1892003
FritzellPHäggOWessbergPNordwallA: Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976)27:1131–11412002
FritzellPHäggOWessbergPNordwallA: 2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976)26:2521–25342001
HerkowitzHNKurzLT: Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am73:802–8081991
JiyaTSmitTDeddensJMullenderM: Posterior lumbar interbody fusion using nonresorbable poly-ether-ether-ketone versus resorbable poly-L-lactide-co-D,L-lactide fusion devices: a prospective, randomized study to assess fusion and clinical outcome. Spine (Phila Pa 1976)34:233–2372009
KanayamaMTogawaDHashimotoTShigenobuKOhaF: Motion-preserving surgery can prevent early breakdown of adjacent segments: comparison of posterior dynamic stabilization with spinal fusion. J Spinal Disord Tech22:463–4672009
LauberSSchulteTLLiljenqvistUHalmHHackenbergL: Clinical and radiologic 2–4-year results of transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Spine (Phila Pa 1976)31:1693–16982006
MiyakoshiNAbeEShimadaYOkuyamaKSuzukiTSatoK: Outcome of one-level posterior lumbar interbody fusion for spondylolisthesis and postoperative intervertebral disc degeneration adjacent to the fusion. Spine (Phila Pa 1976)25:1837–18422000
MoherDCookDJEastwoodSOlkinIRennieDStroupDF: Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet354:1896–19001999
PichelmannMALenkeLGBridwellKHGoodCRO'LearyPTSidesBA: Revision rates following primary adult spinal deformity surgery: six hundred forty-three consecutive patients followed-up to twenty-two years postoperative. Spine (Phila Pa 1976)35:219–2262010
StroupDFBerlinJAMortonSCOlkinIWilliamsonGDRennieD: Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA283:2008–20122000
SudoHOdaIAbumiKItoMKotaniYMinamiA: Biomechanical study on the effect of five different lumbar reconstruction techniques on adjacent-level intradiscal pressure and lamina strain. J Neurosurg Spine5:150–1552006
SukSILeeCKKimWJLeeJHChoKJKimHG: Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine (Phila Pa 1976)22:210–2201997
ThomsenKChristensenFBEiskjaerSPHansenESFruensgaardSBüngerCE: 1997 Volvo Award winner in clinical studies. The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: a prospective, randomized clinical study. Spine (Phila Pa 1976)22:2813–28221997