The Observation Of Clinical Efficacy Of Lumbar Spondylolisthesis Treated By PLF And PLIF Combined With Pedicle Screws Fixation

Objective: Retrospectively analyzing 57 cases of lumbar spondylolisthesis that received posterolateral lumbar fusionion(PLF) or posterior lumbar interbody fusion(PLIF)and discussing the clinical efficacy of these two surgical measures for lumbar spondylolisthesis.Methods: We collected the patients with single-segment lumbar spondylolisthesis who underwent surgical treatment from April 2009 to April 2014. 57 patients were enrolled due to their complete data. According to the differences between operative approaches and fuse methods, All patients were categorized into two groups. One group contained 31 patients treated by PLIF(13 male, 18 females;13 cases of I° slip, 18 cases of II° slip), and vertebral body slippage was as follows: L3(6 cases), L4(11 cases), L5(14cases).The other group included 26 patients treated by PLF(11 cases of I° slip, 15 cases of II° slip), and vertebral body slippage was as follows: L3(4 cases), L4(10 cases), L5(12cases). All the patients’ documents were recorded based on X-ray film to L-Spine PA &LAT and(or) lumbar CT scan in preoperation, postoperation and last follow-up time.which were used to evaluate patients’ postoperative retention rate of relative intervetebral space height, lumbar fusion rate, segmented lordosis angle, reduction of spondylolisthesis and loss rate. The whole data was statistically assessed by SPSS ver.19.0. P>0.05 represented no significant meaning, and P<0. 05 was just opposite.Results:(1) There was no difference among age, gender, Meyerding grade and JOA scores sothat there was no statistical value between the two groups(P>0. 05) that proved considerable comparability(PLF vs PLIF).(2) Duration of operation, hemorrhage during operation between two surgical methods were obvious different and statistically meaningful(P<0. 01).(3) There was significant difference in pre- and post-operative JOA scores between two groups(P<0. 01), whereas recovery rate was absent(P>0.05). Statistical differences existed in BVAS and LVAS between pre- and post-operation and in BVAS in last follow-up time between two groups(P<0. 01). But there was no difference in LVAS in last follow-up time between two groups(P>0.05).(4) Compared with relative intervetebral space height, segmented lordosis angle in preoperation, these variates in postoperation and last follow-up time acquired better outcomes(P<0.01). The relative intervetebral space height, segmented lordosis angle(postoperation) between two groups was no significant difference(P>0.05) and segmented lordosis angle(last follow-up time) was as well(P>0.05), but relative intervetebral space height(last follow-up time) between two groups was statistically meaningful(P<0.01). The slip rate of patients of PLF group in postoperation had improved more than that in preoperation(P<0.01). The slip rate of patients of PLF group in last follow-up time had lost more than that in postoperation(P<0.01). The slip rate of patients of PLIF group in postoperation had improved more than that in preoperation(P<0.01). The slip rate of patients of PLIF group in last follow-up time had no obvious loss compared with in postoperation(P>0.05). The between-group slip rate between in postoperation and last follow-up time had significant value(P<0.01).(5) There was no significant difference for good rate(P>0.05) but obvious meaning for fusion rate(P<0.01).Conclusion:(1) The fusion methods which include PLF and PLIF could be feasible ways to treat low-degree lumbar spondylolisthesis.(2) PLIF could perform better stability and duration than PLF in rebuilding, and superior mechanical property such as maintainance of shaping and stable structure is proved from patients treated by PLIF. Also PLIF might show some significant advantages:high fusion rate, low failure rate of fixation and less loss of lumbar slip rate and intervetebral space height.(3) Compared with PLIF, PLF shows better in easy operation, short duration time and less hemorrhage. Although loss of shape and failure of fixation occurred in our retrospect,clinical outcomes might have no obvious difference between PLF and PLIF.