Comparison Of Posterior Lumbar Interbody Fusion Combined With Posterolateral Fusion And Posterolateral Fusion In Lumbar Degenerative Diseases

Objective:To compare the outcome of posterior lumbar interbody fusion combined with posterolateral fusion and stand-alone posterolateral fusion in lumbar degenerative diseases.Method:A total of 89 patients with lumbar degenerative diseases were reviewed.50 patients were operated on with posterior lumbar interbody fusion combined with posterolateral fusion (PLIF+PLF group) and pedicle fixation,39 patients were operated on with posterolateral fusion (PLF group) and pedicle fixation.The two groups had similar age and sex distribution, and level of pain. Inclusion criteria and outcome measurements were identical in both groups. The PLIF+PLF group were operated on with single PEEK cage in 30 cases, autologous tricortical iliac grafts in 2 cases, and autologous granular cancellous bone in 18 cases. Radiographic manifestations and clinical outcomes after surgery were compared between the two groups.Result:The mean follow-up period was 8.9 months.There was no statistically significant difference in mean operating time,blood loss and hospital time between the two groups,however,the cost of hospitalization in the PLIF+PLF group was significantly higher than that in the PLF group. There was also no statistically significant difference in the incidence of the complication,the intervertebral disc height,the total lumbar lordosis and the fusion segmental angle of lordosis between the two groups. The clincal outcome of the patients was evaluated by means of 4-grade scale including excellent,good,fair and poor. There were 18 cases of excellent,26 cases of good,4 cases of fair, and 2 cases of poor results in the PLIF+PLF group. There were 15 cases of excellent,19 cases of good,4 cases of fair, and 1 case of poor results in the PLF group. The rate of excellent and good together was 88% in the PLIF+PLF group, and 87.2% in the PLF group (P＞0.05).Conclusion:Combining posterior lumbar interbody fusion with posterolateral fusion does not significantly improve the short outcome of surgical treatment of the lumbar degenerative diseases, compared with stand-alone posterolateral fusion.