Effect Of Transforaminal Lumbar Interbody Fusion Combined With Contralateral Laminectomy In The Treatment Of Lumbar Spondylolisthesis

Objective To compare the clinical efficacy of posterior lumbar interbody fusion(PLIF)and transforaminal lumbar interbody fusion(TLIF)combined with contralateral laminectomy in the treatment of lumbar spondylolisthesis.Method The data of 156 patients with degenerative lumbar spondylolisthesis who were surgically treated and followed up from June 2015 to June 2019 were retrospectively analyzed.According to the surgical methods,the patients were divided into two groups,of which 81 patients underwent PLIF(PLIF group,18 males and 63 females,age 63.4±9.3 years)and 75 patients underwent TLIF combined with contralateral laminectomy(TLIF fenestration group,19 males and 56 females,age65.6±8.9 years).The general data,operation time,bleeding volume,fusion rate and postoperative complications were recorded.The parameters such as the height of the posterior edge of the intervertebral space,the lumbar lordosis and the degree of reduction of spondylolisthesis were measured.The visual analog scale(VAS)and Oswestry disability index(ODI)were compared before and after operation.Results The operation time,bleeding volume and drainage volume of TLIF group were significantly better than those of PLIF group(P < 0.01).The posterior edge height of intervertebral space and lumbar lordosis angle of the two groups were significantly improved compared with those before operation(P < 0.001),but there was no significant difference between the two groups before and after operation(P >0.05).The reduction rates of slippage in the two groups were 81.4% in PLIF group and 83.9% in TLIF windowing group.VAS scores of postoperative low back pain and leg pain in the two groups were significantly lower than those before operation.There was no significant difference between the two groups before and after operation.The postoperative ODI index of PLIF group and TLIF fenestration group were 26.3% ±8.1% and 29.6% ± 9.0% respectively,which were significantly lower than 63.5% ±12.7% and 62.6% ± 10.4% before operation(P < 0.01).There was no significant difference between the two groups before and after operation(P > 0.05).The quality of life of the two groups improved equally.At the last follow-up,both groups achieved bone fusion without internal fixation related complications.The incidence of complications was 6.17%(5/81)in PLIF group and 5.33(4/75)in TLIF windowing group.There was no significant difference between the two groups.Conclusion PLIF and TLIF combined with contralateral laminectomy are both effective methods for the treatment of lumbar spondylolisthesis.TLIF combined with contralateral laminectomy has less bleeding and less trauma,which is more conducive to the early rehabilitation of patients.