Curative Effect Comparison Of The Posterolateral Lumbar Fusion And Transforaminal Lumbar Interbody Fusion In The Treatment On Degenerative Lumbar Spondylolisthesis

Objective: It is to analyze and compare postoperative clinical efficacy ondegenerative lumbar spondylolisthesis between posterolateral lumbar fusion（PLF）accompanied with decompression,reduction and fixation by screw-rods system andtransforaminal lumbar interbody fusion （TLIF） accompanied withdecompression,fusion with cage,reduction and fixation by screw-rods system, and thento analyze the related factors of influence.Methods: We selected37degenerative lumbar spondylolisthesis patients fromMarch2006to March2006in the First Affiliated Hospital of Dalian MedicalUniversity(age among46to76,average age59;L_3-4 segment spondylolisthesis2cases,L_4-5 segment spondylolisthesis31cases, L5-S1segment spondylolisthesis4cases;slip degree of I°29cases,II°8cases),and divided into2groups by differentoperations.Group A is consisted with24cases treated by posterolateral lumbarfusion（PLF） accompanied with decompression,reduction and fixation by screw-rodssystem.Group B is consisted with13cases treated by transforaminal lumbar interbodyfusion （TLIF） accompanied with decompression,fusion with cage,reduction and fixationby screw-rods system.It is a retrospective study.We analyze and compare the totaloperation time and the blood loss.We also record the intervertebral height and slip rateamong preoperation,postoperation and follow-up.Meanwhile, fusion rate of bone graftsby1,3,6,12month follow-up X-ray is another record. Finally, we evaluate the clinicalefficacy of the patients by VAS and ODI.Results：1.The total operation time in Group A is203.04±19.23min,and that is306.67±51.40min in Group B;the blood loss in Group A is323.91±109.62ml,and that is 575.00±222.08ml in Group B,The differences between the two groups with the totaloperation time and blood loss are statistically significant （P<0.05）.Two cases ofpatients meningeal tear;two cases of postoperative radicular symptoms get worse;thecage location is good,no loosening,fracture and other complications appear in all of thepatients.2.In Group A,the preoperative slip percents is20.25±3.38and the postoperativeone is3.58±1.61;In Group B,the preoperative slip percents is19.50±6.74and thepostoperative one is3.43±0.84.The differences between preoperation and postoperationare statistically significant （P<0.05）.The loss of slip reduction by finally follow-up inGroup A is2.05±0.92, and in Group B is0.61±0.38,then the difference is statisticallysignificant （P<0.05）.In Group A,the preoperative intervertebral height is6.58±0.78mmand the postoperative one is10.70±0.96mm;In Group B,the preoperative intervertebralheight is6.56±0.58mm and the postoperative one is11.58±0.74mm.The differencesbetween preoperation and postoperation are statistically significant （P<0.05）. The lossof intervertebral height by finally follow-up in Group A is1.17±1.11mm, and in GroupB is0.10±0.07mm, then the difference is statistically significant （P<0.05）.The fusionrate of total34cases is91.9%. In Group A,there are21cases in completed fusion and3cases in probable fusion, and the rate is87.5%;In Group B, there are13cases incompleted fusion,then the rate is100%.3.In Group A, the preoperative VAS score is6.43±1.04and the postoperative one is1.52±1.08;In Group B, the preoperative VASscore is6.42±1.08and the postoperative one is1.42±1.08. The differences betweenpreoperation and postoperation are statistically significant （P<0.05） and thepostoperative difference is not statistically significant （P>0.05）. The VAS score byfinally follow-up in Group A is1.91±1.20, and that is1.00±0.85in Group B, and thedifference between the two groups is statistically significant （P<0.05）.In Group A, thepreoperative ODI score is40.96±2.38and the postoperative one is12.36±2.58;In GroupB, the preoperative ODI score is41.47±2.54and the postoperative one is12.41±2.92.The differences between preoperation and postoperation are statisticallysignificant （P<0.05） and the postoperative difference is not statistically significant（P>0.05）. The ODI score by finally follow-up in Group A is13.33±3.22, and that is9.42±2.71in Group B, and the difference between the two groups is statisticallysignificant （P<0.05）.Conclusion:1.Both the two surgical approach have good effect on rectification ofslip rate and intervertebral height, but TLIF with cage has less loss of reduction rate and intervertebral height. Both the methods have good postoperative fusion rate, but TLIFwith cage is preferable because of its higher fusion rate.2.Both the two surgicalapproach can distinctly relive the pain of the patients,but TLIF with cage is preferablein the long-term clinical efficacy.