Artikel
Posterior lumbar interbody fusion (PLIF) - Still a treatment option for degenerative lumbar spondylosis? A case control study evaluating clinical and functional outcome
"Posterior lumbar interbody fusion (PLIF)" - immer noch eine Behandlungsoption bei degenerativen lumbalen Spondylosen? Eine Fallkontrollstudie zur Bewertung klinischer und funktioneller Behandlungsergebnisse
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Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
According to the Cochrane Review ´surgery for degenerative lumbar spondylosis´, an excellent metaanalysis evaluating the whole literature dealing with lumbar spondylosis treatment options up to 12 / 1999, there is no evidence that surgery for lumbar spondylolisthesis leads to better outcome than conservative treatment or natural history. We took this provocative result as a reason to reevaluate the functional outcome of our patients treated with posterior lumbar interbody fusion (PLIF) for degenerative lumbar spondylolisthesis.
Methods
From 1996 to 2002 we used a standardized instrumented posterior lumbar interbody fusion technic (HARMS et al.) to treat 41 (male 28 : female 13) consecutive patients (aged 33 - 84 years, mean 59,7 years) for degenerative lumbar spondylolisthesis. Indication for surgery was radiologically proven degenerative spondylolisthesis and instability together with failure of conservative treatment for more than 3 months. Radiological and clinical follow-up was estimated every 3 months. Comorbidity was reevaluated as a prognostic outcome factor, neurological status was estimated pre- and postoperatively according to the FRANKEL score, radiological criteria was used to estimate the fusion rate, a life-quality-score was used to evaluate subjective criteria.
Results
We found a perioperative morbidity of 9,8% including deep wound infections in 3 cases with full recovery, and 1 severe case of persistent neurologic deterioration. There was no postoperative mortality. 1 patient was lost to follow-up. Operation led to the subjective impression of a better quality of life for 73,2% or at least no deterioration for another 12,2%. The rate of objective decrease of neurologic deficits according to the FRANKEL score was low. We found a fusion rate of 73,2%. Though comorbidity was deemed an important outcome factor in other studies it did not play a significant role in our patients.
Conclusions
Objective improvement of neurological deficits following PLIF is low, however there was a markable subjective benefit for more than 70% of our patients. Our objective results support the Cochrane Review. There is no evidence regarding benefits from surgical treatment of lumbar spondylolisthesis but an urgent need for a randomized controlled multicenter study comparing surgical treatment data to natural history of spondylolisthesis.