Comparison of Functional and Radiological Outcomes of Transforaminal Lumbar Interbody Fusion and Posterolateral Fusion Techniques in the Treatment of Lumbar Spinal Stenosis

Abstract

Background This study aimed to compare posterolateral fusion with transforaminal lumbar interbody fusion (PLF + TLIF) and PLF only in terms of revision surgery rates and complications, as well as functional and radiological outcomes in lumbar spinal stenosis (LSS) patients.

Methods Seventy-one patients (37 patients in the PLF + TLIF group and 34 patients in the PLF only group) who underwent surgery due to LSS between January 2013 and December 2016 were retrospectively investigated. Functional evaluation was performed by using the McGill-Melzack Pain Questionnaire (MPQ), Roland Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI) scales pre-and postoperatively. Radiological evaluation was made by examining adjacent vertebrae, posterior ligamentous complex (PLC) morphology, and sagittal balance on magnetic resonance imaging (MRI).

Results Postoperative MPQ, RMDQ, and ODI scores were significantly better in the PLF + TLIF group (p < 0.001, p < 0.001, and p = 0.001, respectively). The complication rate was significantly higher in the PLF only group (p = 0.026). In the PLF + TLIF group, postoperative functional scores showed significant improvement in terms of the instrumented segment and level of interbody fusion. Postoperative functional scores showed significant improvement in PLF + TLIF patients with no complications, no revision surgery, no postoperative MRI findings, and neutral sagittal balance compared to the preoperative functional scores (p < 0.001).

Conclusion PLF + TLIF is significantly superior in terms of functional scores and complications, despite the statistical similarity in terms of postoperative MRI findings and sagittal balance between the groups. Surgeons should prefer PLF + TLIF for the surgical treatment of LSS for better results.

Zusammenfassung

Einleitung Diese Studie vergleicht die Revisionsoperationsraten, Komplikationen, funktionellen und radiologischen Ergebnisse bei Patienten mit lumbaler Spinalkanalstenose (SKS) zwischen den Behandlungsmethoden der posterolaterale Fusion (PLF) mit der transforaminalen Zwischenkörperfusion (ZKF) und nur der PLF.

Methoden Von Januar 2013 bis Dezember 2016 wurden 71 Patienten (37 Patienten in der PLF + ZKF-Gruppe und 34 Patienten in der PLF-Gruppe), aufgrund von SKS operiert. Die Funktionsbewertung wurde prä- und postoperativ mit den Skalen McGill-Melzack Pain Questionnaire (MPQ), Roland Morris Disability Questionnaire (RMDQ) und Oswestry Disability Index (ODI) durchgeführt. Die radiologische Bewertung erfolgte durch Untersuchung benachbarter Wirbel, der Morphologie des hinteren Ligamentkomplexes und des sagittalen Gleichgewicht der Wirbelsäule bei der Magnetresonanztomografie (MRT).

Ergebnisse Die postoperativen MPQ-, RMDQ- und ODI-Werte waren in der PLF + ZKF-Gruppe signifikant besser (p < 0,001, p < 0,001 bzw. p = 0,001). Die Komplikationsrate wurde in der PLF-Gruppe signifikant höher beobachtet (p = 0,026). Postoperative funktionelle Score zeigten eine signifikante Verbesserung bei PLF + ZKF-Gruppe. Postoperativen funktionellen Score verbessert bei der Patienten ohne Komplikationen, ohne Revisionschirurgie, ohne postoperative MRT-Befunde und mit neutralem sagittalem Wirbelsäulengesamtstatik im Vergleich zu den präoperativen funktionellen Score (p < 0,001).

Zusammenfassung PLF + ZKF ist in Bezug auf funktionelle Score und Komplikationen trotz der statistischen Ähnlichkeit in Bezug auf postoperative MRT-Befunde und das sagittale Gleichgewicht der Wirbelsäule zwischen den Gruppen signifikant überlegen. Chirurgen sollten PLF + ZKF für die chirurgische Behandlung von SKS bevorzugen, um bessere Ergebnisse zu erzielen.

Key words

lumbar spinal stenosis - transforaminal lumbar interbody fusion - posterolateral fusion - functional and radiological outcomes

Schlüsselwörter

Spinalkanalstenose - transforaminale Zwischenkörperfusion - posterolaterale Fusion - funktionelle und radiologische Ergebnisse

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