Comparative study of posterolateral fusion versus combination of posterolateral and posterior lumbar interbody fusion in spondylolisthesis treated with posterior decompression and pedicle screw fixation

Background: Spondylolisthesis is defi ned as forward slippage of cephalad vertabra on a caudal vertebra. It is a combination of 2 greek words-Spondylos (Vertebra) and Olisthanein (to slip or fall). Spondylolysis is the most common cause of low back pain in adolescents and about 15% to 25% of patients of spondylolysis will ultimately develop spondylolisthesis.

Methods: The study was conducted to compare the Clinical and the Functional outcome of Posterolateral fusion versus combination of Posterolateral and Posterior lumbar interbody fusion in spondylolisthesis treated with posterior decompression and pedicular screw fi xation performed between March 2015 and March 2016,fi rst 13 patients consecutive patients underwent Posterolateral Fusion (PLF) while last 13 patients underwent combination of posterolateral fusion and Posterior Lumbar Interbody Fusion (PLIF). The clinical outcome was evaluated according to the Visual Analogue Scale (VAS) and functional outcome was evaluated according to Oswestry Disability Index (ODI).

Results: Maximum patients were in age group of 51-60 years in both groups with mean age of presentation being 47.3 years. Low backache was the most common symptom being present in 100% of patients. Radicular pain and claudication were the next most common symptoms.

This study shows that in group 2 where patients were treated with combination of PLIF and PLF 76.9% of patients had Grade 2 fusion while only 38.5% of patients in group 1 had Grade 2 fusion (p=0.025). ODI and VAS also improved more in group 2 and this diff erence was statistically signifi cant (p<.001).

Conclusion: Combination of posterolateral and posterior lumbar interbody provides good clinical,functional and radiological outcome with less complications as compared PLF alone.