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Tlif Versus Plif In Management Of Low Grade Spondylolisthesis

A Yehya


Background: Spinal fusion is commonly performed together with rigid instrumentation to treat low-grade spondylolisthesis. Several fusion methods have been reported for low-grade spondylolisthesis via various approaches including posterolateral fusion (PLF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), and anterior lumbar interbody fusion (ALIF) The choice of lumbar fusion technique must be individualized based on the clinical needs of each patient, and the surgical outcome for each procedure.
Aim of the work: This study was done to evaluate the results obtained in patients undergoing TLIF compared with PLIF with pedicle screw fixation for the treatment of low grade spondylolisthesis.
Material and Methods: This study was carried out on sixty patients fulfilling the selected criteria, admitted to the neurosurgery department of the Main Alexandria University hospital between January 2005 and December 2008, thirty consecutive patients underwent transforaminal lumbar interbody fusion (group I) and another thirty consecutive patients underwent posterior lumbar interbody fusion (group II). Patients have been followed up clinically and radiologically for a period ranged from 6-18 months.
Results: The mean VAS for back and leg pain significantly decreased from 6.99 ± 0.9 to 2.1±0.7 and 6.4±0.8 to 2.0±0.9 in group I and from 7.37±1.0 to 1.7±0.7 and 6.3±0.7 to 1.6±0.8 in group II, respectively, (P < 0.05). The average pre operative disk and foramen height in the TLIF group improved from 6.4±1.1 and 14.9±0.9 preoperatively to 11.4±0.8 and 18.5±0.6 postoperatively, respectively. At last follow up there was minimal loss of correction down to 10.6±0.7 and 18.0±0.5 respectively. Similarly in the PLIF group, preoperative disk and foramen height were improved from 6.7±0.7 and 14.6±0.3 to 11.5±0.5 and 18.3±0.7 immediately post operative. At last follow up minimal loss of correction was noted with average disc height of 10.8±0.4 and 17.7±0.7 respectively. Both groups achieve statistically significant difference in restoration of disc and foramen height from the preoperative and postoperative, (P < 0.05). But, there was no statistically significant difference between the two groups. In group I there were 22 cases (73.3%) of excellent, 8 cases (26.7%) of good, and no cases of fair results, but in group II there were 20 cases (66.7%) of excellent, 9 cases (30%) of good, and 1 case (3.3%) of fair results.
Conclusion: Interbody fusion with either a PLIF technique or a TLIF technique provides good outcome in the treatment of low grade spondylolisthesis. The TLIF procedure is simpler and safer than PLIF with very good outcome. So, TLIF technique offers a useful alternative to the more traditional PLIF procedure.

Keywords: Spondylolisthesis, Interverterbral fusion, TLIF, PLIF.