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

Publication History

Article published online:
18 May 2021

• References

• 1 Thomé C, Börm W, Meyer F. Die degenerative lumbale Spinalkanalstenose (Aktuelle Strategien in Diagnostik und Therapie). Dtsch Arztebl 2008; 105: 373-379
• 2 Zarghooni K, Beyer F, Papadaki J. et al. Lebensqualität und funktionelles Ergebnis nach mikrochirurgischer Dekompression bei lumbaler Spinalkanalstenose – eine Registerstudie. Z Orthop Unfall 2017; 155: 429-434
• 3 Korge A, Mehren C, Reutten S. Minimal-invasive Dekomppressionsverfahren der Spinalkanalstenose. Orthopäde 2019; 48: 824-830
• 4 Siebert E, Pruss H, Klingebiel R. et al. Lumbar spinal stenosis: syndrome, diagnostics and treatment. Nat Rev Neurol 2009; 5: 392-403
• 5 Hermansen E, Romild UK, Austevoll IM. et al. Does surgical technique influence clinical outcome after lumbar spinal stenosis decompression? A comparative effectiveness study from the Norwegian Registry for Spine Surgery. Eur Spine J 2017; 26: 420-427
• 6 Lee SH, Chung B, Lee HY. et al. A comparison between interspinous ligamentoplasty, posterior interbody fusion, and posterolateral fusion in the treatment of grade I degenerative lumbar spondylolisthesis. Joint Dis Rel Surg 2005; 16: 111-117
• 7 Overdevest G, Vleggeert-Lankamp C, Jacobs W. et al. Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis. Eur Spine J 2015; 24: 2244-2263
• 8 Mobbs RJ, Li J, Sivabalan P. et al. Outcomes after decompressive laminectomy for lumbar spinal stenosis: comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy: clinical article. J Neurosurg Spine 2014; 21: 179-186
• 9 Joaquim AF, da Silva OT, Benkli B. et al. Degenerative Lumbar Spine Disease. In: Joaquim A, Ghizoni E, Tedeschi H, Ferreira M. eds. Fundamen-tals of Neurosurgery. Cham: Springer; 2019: 211-220
• 10 Burgstaller JM, Porchet F, Steurer J. et al. Arguments for the choice of surgical treatments in patients with lumbar spinal stenosis–a systematic appraisal of randomized controlled trials. BMC Musculoskelet Disord 2015; 16: 96
• 11 Wang H, Ma L, Yang D. et al. Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders. Medicine (Baltimore) 2017; 96: e6032
• 12 Glassman SD, Berven S, Bridwell K. et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976) 2005; 30: :682-688
• 13 Pfirrmann CW, Metzdorf A, Zanetti M. et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 2001; 26: 1873-1878
• 14 Fujiwara A, Tamai K, Yamato M. et al. The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J 1999; 8: 396-401
• 15 Duramaz A, Karaali E, Öztürk V. et al. Importance of lowest instrumented vertebra on clinical and radiological outcomes in patients with Lenke type 3C adolescent idiopathic scoliosis: a minimum 4-year follow-up. J Pediatr Orthop B 2020; 29: 580-589
• 16 Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain 1975; 1: 277-299
• 17 Yakut E, Düger T, Öksüz Ç. et al. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine (Phila Pa 1976) 2004; 29: 581-585
• 18 Roland M, Fairbank J. The Roland–Morris disability questionnaire and the Oswestry disability questionnaire. Spine (Phila Pa 1976) 2000; 25: :3115-3124
• 19 Zaina F, Tomkins-Lane C, Carragee E. et al. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev 2016; (01) CD010264
• 20 Fujimori T, Le H, Schairer WW. et al. Does Transforaminal Lumbar Interbody Fusion Have Advantages Over Posterolateral Lumbar Fusion for Degenerative Spondylolisthesis?. Global Spine J 2015; 5: 102-109
• 21 Videbaek TS, Christensen FB, Soegaard R. et al. Circumferential fusion improves outcome in comparison with instrumented posterolateral fusion: long-term results of a randomized clinical trial. Spine (Phila Pa 1976) 2006; 31: 2875-2880
• 22 Høy K, Bünger C, Niederman B. et al. Transforaminal lumbar interbody fusion (TLIF) versus posterolateral instrumented fusion (PLF) in degenerative lumbar disorders: a randomized clinical trial with 2-year follow-up. Eur Spine J 2013; 22: 2022-2029
• 23 Wang YP, Fei Q, Qiu GX. et al. Outcome of posterolateral fusion versus circumferential fusion with cage for lumbar stenosis and low degree lumbar spondylolisthesis. Chin Med Sci J 2006; 21: 41-47
• 24 Gaffney CJ, Pinto MR, Buyuk AF. et al. Posterolateral versus transforaminal interbody L4/5 fusion. Clin Spine Surg 2019; 32: E91-E98
• 25 Mummaneni PV, Dhall SS, Eck JC. et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 11: interbody techniques for lumbar fusion. J Neurosurg Spine 2014; 21: 67-74
• 26 Kozak JA, OʼBrien JP. Simultaneous combined anterior and posterior fusion. An independent analysis of the treatment of the disabled low-back pain patient. Spine (Phila Pa 1976) 1990; 15: 322-328
• 27 Kim JS, Jung B, Lee SH. Instrumented Minimally Invasive Spinal-Transforaminal Lumbar Interbody Fusion (MIS-TLIF). Clin Spine Surg 2018; 31: E302-E309
• 28 Nakashima H, Kawakami N, Tsuji T. et al. Adjacent segment disease after posterior lumbar interbody fusion. Spine (Phila Pa 1976) 2015; 40: :831-841
• 29 Kowalski RJ, Ferrara LA, Benzel EC. Biomechanics of bone fusion. Neurosurg Focus 2001; 10: E2
• 30 Dorward IG, Lenke LG, Stoker GE. et al. Radiographical and clinical outcomes of posterior column osteotomies in spinal deformity correction. Spine (Phila Pa 1976) 2014; 39: 870-880