title: Two-level posterior lumbar interbody fusion for degenerative disc disease: improved clinical outcome with restoration of lumbar lordosis.
abstract: BACKGROUND
  Although posterior lumbar interbody fusion (PLIF) for degenerative lumbar diseases is routine, there are few reports on double-level PLIF.
  
  
  OBJECTIVE
  To evaluate the clinical outcomes of double-level PLIF.
  
  
  METHODS
  A retrospective study of operated cases in Gifu, Japan.
  
  
  METHODS
  Nineteen patients (8 men and 11 women, 59.5+/-10.2 years) who underwent double-level PLIF between 1996 and 2001.
  
  
  METHODS
  Operation time, blood loss, complications, the Japanese Orthopaedic Association (JOA) score for back pain and lumbar sagittal alignment were evaluated.
  
  
  METHODS
  Patients were examined retrospectively at follow-ups of 3.6+/-1.7 years. Primary diseases were spondylolisthesis, spinal canal stenosis, degenerative scoliosis and herniated intervertebral disc. Fusion areas were L3 to L5 in 15 cases and L4 to S1 in 4 cases.
  
  
  RESULTS
  The mean JOA score increased from an initial score of 12.9+/-3.5 to 21.3+/-4.9 at the final follow-up. There was a positive correlation (R=0.718, p<.001) between the increase in lordotic angle and the increase in the JOA score. Several parameters suggested that the surgical invasiveness was not minimal.
  
  
  CONCLUSIONS
  Double-level PLIF provided satisfactory results and preserved lumbar spine lordosis.
authors.affiliation: Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Gifu, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Hioki
authors.forename: Kei
authors.initials: K
authors.lastname: Miyamoto
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Kodama
authors.forename: Hideo
authors.initials: H
authors.lastname: Hosoe
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nishimoto
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Sakaeda
authors.forename: Katsuji
authors.initials: K
authors.lastname: Shimizu
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D008141:Lordosis / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D020127:Recovery of Function; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome