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doi: 10.1097/BRS.0b013e3181973e35
Clinical Case Series

Significantly Improved Outcomes With a Less Invasive Posterior Lumbar Interbody Fusion Incorporating Total Facetectomy

Kasis, Ata G. MRCS; Marshman, Laurence A. G. MD, FRCSN; Krishna, Manoj FRCS, MCh (Orth); Bhatia, Chandra K. MOrth, FRCS

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Study Design. Original study.

Objective. Prospective comparison of clinical outcomes after a standard posterior lumbar interbody fusion (ST-PLIF) and after a limited exposure PLIF incorporating total facetectomy (LI-PLIF).

Summary of Background Data. Most groups have reported significantly improved clinical outcomes after ST-PLIF. To our knowledge, however, a comparison of outcomes between ST-PLIF and the LI-PLIF that we herein describe has not been reported before.

Methods. Patients were included who had suffered chronic low back pain for a minimum of 2 years that was unresponsive to conservative treatment. N = 114 consecutive patients underwent ST-PLIF, whereas n = 209 underwent LI-PLIF. All patients underwent pre- and postoperative evaluations for Oswestry Disability Index (ODI), short-form 36 (SF-36), and visual analogue scores (VAS). The minimum follow-up for either group was 2 years.

Results. There was a significant improvement in the ODI (22.5 ± 1.0, P < 0.001), VAS for back pain (3.8 ± 0.1, P = 0.003), VAS for leg pain (4.0 ± 0.2, P = 0.002), and SF-36 for bodily pain (14.7 ± 0.9, P = 0.012) after ST-PLIF. However, there was a significantly greater improvement in all scores after LI-PLIF: ODI (28.8 ± 1.4 vs. 22.5 ± 1.0, P < 0.001), VAS for back pain (5.4 ± 0.2 vs. 3.8 ± 0.1, P = 0.001), VAS for leg pain (5.1 ± 0.2 vs. 4.0 ± 0.2, P < 0.001), and SF-36 for bodily pain (18.5 ± 0.8 vs. 14.7 ± 0.9, P = 0.003). There was a significantly shorter duration of hospital stay after LI-PLIF (2.24 ± 0.057 days) than after ST-PLIF (4.04 ± 0.13 days) (P = 0.005). Operative complications occurred in 19.3% of ST-PLIF and in 6.7% of LI-PLIF.

Conclusion. Clinical outcomes were significantly improved after both ST-PLIF and LI-PLIF. However, outcomes were significantly better after LI-PLIF than after ST-PLIF. Significantly shortened hospital stay with LI-PLIF probably reflected the “less invasive” technique per se. Significantly better clinical outcomes with fewer complications after LI-PLIF, however, potentially reflected maneuvers singular to LI-PLIF: (1) preservation of posterior elements, (2) avoidance of far lateral dissection over the transverse processes, (3) bilateral total facetectomy, (4) fewer neurologic complications, and (5) avoidance of iliac crest autograft. LI-PLIF is therefore recommended over ST-PLIF.

© 2009 Lippincott Williams & Wilkins, Inc.

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