Posterolateral fusion with interbody for lumbar spondylolisthesis is associated with less repeat surgery than posterolateral fusion alone

Mohamed Macki, Mohamad Bydon, Robby Weingart, Daniel Sciubba, Jean Paul Wolinsky, Ziya L. Gokaslan, Ali Bydon, Timothy Witham

Research output: Contribution to journalArticle

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Abstract

Objective Posterior or transforaminal lumbar interbody fusions (PLIF/TLIF) may improve the outcomes in patients with lumbar spondylolisthesis. This study aims to compare outcomes after posterolateral fusion (PLF) only versus PLF with interbody fusion (PLF + PLIF/TLIF) in patients with spondylolisthesis. Methods We retrospectively reviewed103 patients who underwent first-time instrumented lumbar fusions for degenerative or isthmic spondylolisthesis. Anterior techniques and multilevel interbody fusions were excluded. All patients were followed for at least 2 years postoperatively. Clinical outcomes including back pain, radiculopathy, weakness, sensory deficits, and loss of bowel/bladder function were ascertained from clinic notes. Radiographic measures were calculated with Tillard percentage of spondylolisthesis. Reoperation for progression of degenerative disease, a primary endpoint, was indicated for all patients with (1) persistent or new-onset neurological symptoms; and (2) radiographic imaging that correlated with clinical presentation. Results Of the 103 patients, 56.31% were managed with PLF and 43.69% with PLF + PLIF/TLIF. On radiographic studies, spondylolisthesis improved by a mean of 13.06% after PLF + PLIF/TLIF versus 5.67% after PLF (p < 0.001). In comparison to PLF + PLIF/TLIF, patients undergoing PLF experienced higher rates of postoperative improvement in back pain, sensory deficits, motor weakness, radiculopathy, and bowel/bladder difficulty; however, these differences did not reach statistical significance. The PLF cohort had a significantly higher incidence of reoperation (p = 0.011) and pseudoarthrosis/instrumentation failure (p = 0.043). In the logistical analyses, non-interbody fusion was the strongest predictor of reoperation for progression of degenerative disease. Conclusion Compared to PLF only, PLF + PLIF/TLIF were statistically significantly associated with a greater correction of spondylolisthesis. Patients with interbody fusions were less likely to undergo reoperation for degenerative disease progression compared to non-interbody fusions. However, greater listhesis correction and decreased reoperation in the PLF + PLIF/TLIF cohort should be weighed with favorable clinical outcomes in the PLF cohort.

Original languageEnglish (US)
Pages (from-to)117-123
Number of pages7
JournalClinical Neurology and Neurosurgery
Volume138
DOIs
StatePublished - Nov 28 2015
Externally publishedYes

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Spondylolisthesis
Reoperation
Disease Progression
Radiculopathy
Back Pain
Urinary Bladder
Pseudarthrosis
Incidence

Keywords

  • Interbody
  • Lumbar
  • PLIF
  • Posterolateral fusion
  • Spondylolisthesis
  • TLIF

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Posterolateral fusion with interbody for lumbar spondylolisthesis is associated with less repeat surgery than posterolateral fusion alone. / Macki, Mohamed; Bydon, Mohamad; Weingart, Robby; Sciubba, Daniel; Wolinsky, Jean Paul; Gokaslan, Ziya L.; Bydon, Ali; Witham, Timothy.

In: Clinical Neurology and Neurosurgery, Vol. 138, 28.11.2015, p. 117-123.

Research output: Contribution to journalArticle

Macki, Mohamed ; Bydon, Mohamad ; Weingart, Robby ; Sciubba, Daniel ; Wolinsky, Jean Paul ; Gokaslan, Ziya L. ; Bydon, Ali ; Witham, Timothy. / Posterolateral fusion with interbody for lumbar spondylolisthesis is associated with less repeat surgery than posterolateral fusion alone. In: Clinical Neurology and Neurosurgery. 2015 ; Vol. 138. pp. 117-123.
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abstract = "Objective Posterior or transforaminal lumbar interbody fusions (PLIF/TLIF) may improve the outcomes in patients with lumbar spondylolisthesis. This study aims to compare outcomes after posterolateral fusion (PLF) only versus PLF with interbody fusion (PLF + PLIF/TLIF) in patients with spondylolisthesis. Methods We retrospectively reviewed103 patients who underwent first-time instrumented lumbar fusions for degenerative or isthmic spondylolisthesis. Anterior techniques and multilevel interbody fusions were excluded. All patients were followed for at least 2 years postoperatively. Clinical outcomes including back pain, radiculopathy, weakness, sensory deficits, and loss of bowel/bladder function were ascertained from clinic notes. Radiographic measures were calculated with Tillard percentage of spondylolisthesis. Reoperation for progression of degenerative disease, a primary endpoint, was indicated for all patients with (1) persistent or new-onset neurological symptoms; and (2) radiographic imaging that correlated with clinical presentation. Results Of the 103 patients, 56.31{\%} were managed with PLF and 43.69{\%} with PLF + PLIF/TLIF. On radiographic studies, spondylolisthesis improved by a mean of 13.06{\%} after PLF + PLIF/TLIF versus 5.67{\%} after PLF (p < 0.001). In comparison to PLF + PLIF/TLIF, patients undergoing PLF experienced higher rates of postoperative improvement in back pain, sensory deficits, motor weakness, radiculopathy, and bowel/bladder difficulty; however, these differences did not reach statistical significance. The PLF cohort had a significantly higher incidence of reoperation (p = 0.011) and pseudoarthrosis/instrumentation failure (p = 0.043). In the logistical analyses, non-interbody fusion was the strongest predictor of reoperation for progression of degenerative disease. Conclusion Compared to PLF only, PLF + PLIF/TLIF were statistically significantly associated with a greater correction of spondylolisthesis. Patients with interbody fusions were less likely to undergo reoperation for degenerative disease progression compared to non-interbody fusions. However, greater listhesis correction and decreased reoperation in the PLF + PLIF/TLIF cohort should be weighed with favorable clinical outcomes in the PLF cohort.",
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T1 - Posterolateral fusion with interbody for lumbar spondylolisthesis is associated with less repeat surgery than posterolateral fusion alone

AU - Macki, Mohamed

AU - Bydon, Mohamad

AU - Weingart, Robby

AU - Sciubba, Daniel

AU - Wolinsky, Jean Paul

AU - Gokaslan, Ziya L.

AU - Bydon, Ali

AU - Witham, Timothy

PY - 2015/11/28

Y1 - 2015/11/28

N2 - Objective Posterior or transforaminal lumbar interbody fusions (PLIF/TLIF) may improve the outcomes in patients with lumbar spondylolisthesis. This study aims to compare outcomes after posterolateral fusion (PLF) only versus PLF with interbody fusion (PLF + PLIF/TLIF) in patients with spondylolisthesis. Methods We retrospectively reviewed103 patients who underwent first-time instrumented lumbar fusions for degenerative or isthmic spondylolisthesis. Anterior techniques and multilevel interbody fusions were excluded. All patients were followed for at least 2 years postoperatively. Clinical outcomes including back pain, radiculopathy, weakness, sensory deficits, and loss of bowel/bladder function were ascertained from clinic notes. Radiographic measures were calculated with Tillard percentage of spondylolisthesis. Reoperation for progression of degenerative disease, a primary endpoint, was indicated for all patients with (1) persistent or new-onset neurological symptoms; and (2) radiographic imaging that correlated with clinical presentation. Results Of the 103 patients, 56.31% were managed with PLF and 43.69% with PLF + PLIF/TLIF. On radiographic studies, spondylolisthesis improved by a mean of 13.06% after PLF + PLIF/TLIF versus 5.67% after PLF (p < 0.001). In comparison to PLF + PLIF/TLIF, patients undergoing PLF experienced higher rates of postoperative improvement in back pain, sensory deficits, motor weakness, radiculopathy, and bowel/bladder difficulty; however, these differences did not reach statistical significance. The PLF cohort had a significantly higher incidence of reoperation (p = 0.011) and pseudoarthrosis/instrumentation failure (p = 0.043). In the logistical analyses, non-interbody fusion was the strongest predictor of reoperation for progression of degenerative disease. Conclusion Compared to PLF only, PLF + PLIF/TLIF were statistically significantly associated with a greater correction of spondylolisthesis. Patients with interbody fusions were less likely to undergo reoperation for degenerative disease progression compared to non-interbody fusions. However, greater listhesis correction and decreased reoperation in the PLF + PLIF/TLIF cohort should be weighed with favorable clinical outcomes in the PLF cohort.

AB - Objective Posterior or transforaminal lumbar interbody fusions (PLIF/TLIF) may improve the outcomes in patients with lumbar spondylolisthesis. This study aims to compare outcomes after posterolateral fusion (PLF) only versus PLF with interbody fusion (PLF + PLIF/TLIF) in patients with spondylolisthesis. Methods We retrospectively reviewed103 patients who underwent first-time instrumented lumbar fusions for degenerative or isthmic spondylolisthesis. Anterior techniques and multilevel interbody fusions were excluded. All patients were followed for at least 2 years postoperatively. Clinical outcomes including back pain, radiculopathy, weakness, sensory deficits, and loss of bowel/bladder function were ascertained from clinic notes. Radiographic measures were calculated with Tillard percentage of spondylolisthesis. Reoperation for progression of degenerative disease, a primary endpoint, was indicated for all patients with (1) persistent or new-onset neurological symptoms; and (2) radiographic imaging that correlated with clinical presentation. Results Of the 103 patients, 56.31% were managed with PLF and 43.69% with PLF + PLIF/TLIF. On radiographic studies, spondylolisthesis improved by a mean of 13.06% after PLF + PLIF/TLIF versus 5.67% after PLF (p < 0.001). In comparison to PLF + PLIF/TLIF, patients undergoing PLF experienced higher rates of postoperative improvement in back pain, sensory deficits, motor weakness, radiculopathy, and bowel/bladder difficulty; however, these differences did not reach statistical significance. The PLF cohort had a significantly higher incidence of reoperation (p = 0.011) and pseudoarthrosis/instrumentation failure (p = 0.043). In the logistical analyses, non-interbody fusion was the strongest predictor of reoperation for progression of degenerative disease. Conclusion Compared to PLF only, PLF + PLIF/TLIF were statistically significantly associated with a greater correction of spondylolisthesis. Patients with interbody fusions were less likely to undergo reoperation for degenerative disease progression compared to non-interbody fusions. However, greater listhesis correction and decreased reoperation in the PLF + PLIF/TLIF cohort should be weighed with favorable clinical outcomes in the PLF cohort.

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KW - Lumbar

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KW - TLIF

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