Significantly improved outcomes with a less invasive posterior lumbar interbody fusion incorporating total facetectomy.
METHODS
Original study.


OBJECTIVE
Prospective comparison of clinical outcomes after a standard posterior lumbar interbody fusion (ST-PLIF) and after a limited exposure PLIF incorporating total facetectomy (LI-PLIF).


BACKGROUND
Most groups have reported significantly improved clinical outcomes after ST-PLIF. To our knowledge, however, a comparison of outcomes between ST-PLIF and the LI-PLIF that we herein describe has not been reported before.


METHODS
Patients were included who had suffered chronic low back pain for a minimum of 2 years that was unresponsive to conservative treatment. N = 114 consecutive patients underwent ST-PLIF, whereas n = 209 underwent LI-PLIF. All patients underwent pre- and postoperative evaluations for Oswestry Disability Index (ODI), short-form 36 (SF-36), and visual analogue scores (VAS). The minimum follow-up for either group was 2 years.


RESULTS
There was a significant improvement in the ODI (22.5 +/- 1.0, P < 0.001), VAS for back pain (3.8 +/- 0.1, P = 0.003), VAS for leg pain (4.0 +/- 0.2, P = 0.002), and SF-36 for bodily pain (14.7 +/- 0.9, P = 0.012) after ST-PLIF. However, there was a significantly greater improvement in all scores after LI-PLIF: ODI (28.8 +/- 1.4 vs. 22.5 +/- 1.0, P < 0.001), VAS for back pain (5.4 +/- 0.2 vs. 3.8 +/- 0.1, P = 0.001), VAS for leg pain (5.1 +/- 0.2 vs. 4.0 +/- 0.2, P < 0.001), and SF-36 for bodily pain (18.5 +/- 0.8 vs. 14.7 +/- 0.9, P = 0.003). There was a significantly shorter duration of hospital stay after LI-PLIF (2.24 +/- 0.057 days) than after ST-PLIF (4.04 +/- 0.13 days) (P = 0.005). Operative complications occurred in 19.3% of ST-PLIF and in 6.7% of LI-PLIF.


CONCLUSIONS
Clinical outcomes were significantly improved after both ST-PLIF and LI-PLIF. However, outcomes were significantly better after LI-PLIF than after ST-PLIF. Significantly shortened hospital stay with LI-PLIF probably reflected the "less invasive" technique per se. Significantly better clinical outcomes with fewer complications after LI-PLIF, however, potentially reflected maneuvers singular to LI-PLIF: (1) preservation of posterior elements, (2) avoidance of far lateral dissection over the transverse processes, (3) bilateral total facetectomy, (4) fewer neurologic complications, and (5) avoidance of iliac crest autograft. LI-PLIF is therefore recommended over ST-PLIF.
Kasis
Ata G
AG
Department of Spinal Surgery, University Hospital of North Tees, Hardwick, Stockton, North Tees. Atakasis@aol.com
Marshman
Laurence A G
LA
Krishna
Manoj
M
Bhatia
Chandra K
CK
D001178:Arthroplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D017116:Low Back Pain / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome