title: Single-level instrumented posterolateral fusion versus non-instrumented anterior interbody fusion for lumbar spondylolisthesis: a prospective study with a 2-year follow-up.
abstract: BACKGROUND
  Surgery for lumbar spondylolisthesis is widely performed. However, there have been no reports comparing posterolateral and anterior interbody fusion prospectively. We compared instrumented posterolateral fusion with anterior interbody fusion for L4 spondylolisthesis in a prospective study.
  
  
  METHODS
  Forty-six patients diagnosed with L4 degenerated spondylolisthesis were divided into two groups. Twenty-two consecutive patients underwent non-instrumented anterior interbody fusion using an iliac bone graft (ALIF; L4-L5 level), and 24 consecutive patients underwent instrumented posterolateral fusion with local bone (PLF; L4-L5 level). The rates of bone union, visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score, Oswestry Disability Index (ODI), surgical invasion, and complications were evaluated before and 2 years after surgery.
  
  
  RESULTS
  Age, VAS score, JOA score, and ODI were not significantly different between the two groups before surgery (P > 0.05). Success of bone union between the two groups was not significantly different (P > 0.05). Blood loss during surgery was significantly less; however, periods of bed rest and hospital stay were significantly longer in the ALIF group (P < 0.05). Overall patient satisfaction, and low back and leg pain in both groups were significantly improved after surgery; however, low back pain showed greater improvement in the ALIF group compared with the PLF group (P < 0.05). Complications such as donor site pain (4 patients in the ALIF group) and dural tearing (3 patients in the PLF group) were observed.
  
  
  CONCLUSIONS
  If single level fusion for L4 spondylolisthesis is performed, both anterior and posterior methods reduce patients' low back and leg pain. Improvement of low back pain was significantly greater after ALIF; however, periods of hospital stay and of bed rest were significantly longer.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. sohtori@faculty.chiba-u.jp
authors.forename: Seiji
authors.initials: S
authors.lastname: Ohtori
authors.forename: Takana
authors.initials: T
authors.lastname: Koshi
authors.forename: Masaomi
authors.initials: M
authors.lastname: Yamashita
authors.forename: Masashi
authors.initials: M
authors.lastname: Takaso
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Yamauchi
authors.forename: Gen
authors.initials: G
authors.lastname: Inoue
authors.forename: Munetaka
authors.initials: M
authors.lastname: Suzuki
authors.forename: Sumihisa
authors.initials: S
authors.lastname: Orita
authors.forename: Yawara
authors.initials: Y
authors.lastname: Eguchi
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Ochiai
authors.forename: Shunji
authors.initials: S
authors.lastname: Kishida
authors.forename: Kazuki
authors.initials: K
authors.lastname: Kuniyoshi
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Aoki
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Gen
authors.initials: G
authors.lastname: Arai
authors.forename: Masayuki
authors.initials: M
authors.lastname: Miyagi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kamoda
authors.forename: Miyako
authors.initials: M
authors.lastname: Suzuki
authors.forename: Junichi
authors.initials: J
authors.lastname: Nakamura
authors.forename: Takeo
authors.initials: T
authors.lastname: Furuya
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Toyone
authors.forename: Masatsune
authors.initials: M
authors.lastname: Yamagata
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D013168:Spondylolisthesis / Q000601:surgery*; D013997:Time Factors