title: Posterolateral instrumented fusion with and without transforaminal lumbar interbody fusion for the treatment of adult isthmic spondylolisthesis: A randomized clinical trial with 2-year follow-up.
abstract: BACKGROUND
  Spondylolisthesis is a common cause of surgery in patients with lower back pain. Although posterolateral fusion and pedicle screw fixation are a relatively common treatment method for the treatment of spondylolisthesis, controversy exists about the necessity of adding interbody fusion to posterolateral fusion. The aim of our study was to assess the functional disability, pain, and complications in patients with spondylolisthesis treated by posterolateral instrumented fusion (PLF) with and without transforaminal lumbar interbody fusion (TLIF) in a randomized clinical trial.
  
  
  METHODS
  From February 2007 to February 2011, 50 adult patients with spondylolisthesis were randomly assigned to be treated with PLF or PLF+TLIF techniques (25 patients in each group) by a single surgeon. Back pain, leg pain, and disability were assessed before treatment and until 2 years after surgical treatment using visual analog scale (VAS) and oswestry disability index (ODI). Patients were also evaluated for postoperative complications such as infection, neurological complications, and instrument failure.
  
  
  RESULTS
  All patients completed the 24 months of follow-up. Twenty patients were females and 30 were males. Average age of the patients was 53 ± 11 years for the PLF group and 51 ± 13 for the PLF + TLIF group. Back pain, leg pain, and disability score were significantly improved postoperatively compared to preoperative scores (P < 0.001). At 3 months of follow-up, there was no statistically significant difference in VAS score for back pain and leg pain in both groups; however, after 6 months and 1 year and 2 years follow-up, the reported scores for back pain and leg pain were significantly lower in the PLF+TLIF group (P < 0.05). The ODI score was also significantly lower in the PLF+TLIF group at 1 year and 2 years of follow-up (P < 0.05). One screw breakage and one superficial infection occurred in the PLF+TLIF group, which had no statistical significance (P = 0.373).
  
  
  CONCLUSIONS
  It seems that accompanying TLIF with PLF might lead to better functional improvement and pain reduction in patients with spondylolisthesis.
authors.affiliation: Department of Orthopedic Spinal Surgery, Isfahan University of Medical Science, Isfahan, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Etemadifar
authors.affiliation: Department of Orthopedic Spinal Surgery, Isfahan University of Medical Science, Isfahan, Iran.
authors.forename: Abdollah
authors.initials: A
authors.lastname: Hadi
authors.affiliation: Department of Orthopedics, Isfahan University of Medical Science, Isfahan, Iran.
authors.forename: Mehran Feizi
authors.initials: MF
authors.lastname: Masouleh
keywords: Posterolateral instrumented fusion (PLF); spine; spondylolisthesis; transforaminal lumbar interbody fusion (TLIF)