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Posterior lumbar interbody fusion (PLIF) surgery: Surgical success and patient satisfaction

1 August 2003


Study design: A retrospective chart review study combined with data from the Oswestry Disability survey (ODI), and SF-36 Quality of life questionnaires.

Objectives: This study is intended to identify and quantify Posterior lumbar interbody fusion (PUF) surgery successes and compare this information to data on Anterior lumbar interbody fusion (ALIF) surgery. Quality of life, patient satisfaction, fusion stability, continued nerve decompression and need for more surgery are parameters investigated. We use surveys combined with chart review of PLIF patients and compare data with that of previous ALIF research.

Background: Lumbar interbody fusion is generally an elective surgical procedure performed to relieve low back pain from segmental instability and/or nerve root compression in the lumbar spine. Indications for this surgery range from intractable back pain and radicular pain occurring over time to sudden nerve compression. Progressive weakness is an urgent indication for surgery. Orthopedic surgeons and neurosurgeons commonly perform spinal fusion with good success and few complications. Neurosurgical advances in technique and instrumentation allow the lumbar' fusion to be performed using a posterior approach or PLIF (posterior lumbar interbody fusion). The PLIF approach uses a small incision, 5-7 cm on average directly over the vertebrae to be fused. After decompression of nerve roots, tangent wedges placed in the interspace maintain the vertebral height and pedicle screws and rod fixation maintain the segmental stability until fusion occurs. This approach necessitates working around delicate spinal nerves with nerve damage as an inherent risk. Anterior approach to lumbar interbody fusion, (ALIF) must traverse abdominal musculature, vasculature and organs, which require longer hospital stays and the possibility of injury to these structures. Mini-open and laparoscopic techniques have been successful thereby reducing risks during an anterior approach.

Methods: Inclusion criteria for the first arm of the study were patients who filled out the SF-36 . (short form 36) quality of life questionnaire within the last 8 months. A retrospective chart review of these patients was performed to compare objective measures of current PLIF technique with the same parameters reported in the literature for AUF. These same patients were asked to complete an Oswestrylow back pain questionnaire (ODI) and contributed to arm 2 of the study. This information was used to compare overall immediate post-surgical disability of PLlF patients to ratings reported for ALIF. In the second arm of the study stability over time and patient satisfaction with PLIF was analyzed by way of current disability ratings 12 to 27 months out from surgery. Inclusion criteria consisted of 150 consecutive patients from October 2000 to March 2002 who underwent PLIF surgery and returned Oswestry questionnaires. ODI surveys contained an additional four questions assessing patient satisfaction. The study was performed as a cross-sectional survey of patients representing a broad spectrum of diagnosis and chronicity.

Results Arm 1: Charts were reviewed for the 72 patients with completed SF-36 pre-op questionnaires to obtain objective data. N=72 The second arm of the study was performed to assess patient satisfaction and disability. N=87 Of the current 72 PLIF patients, 32 returned ODI surveys or 44%. Of the 2000-2001 PLIF group, 55 ODI surveys were returned, n=55 or 36%. Combined data for 1,2,3 and 4 level fusions was compared to that of ALIF data. PLIP was found to result in less blood loss, shorter hospital stays, shorter operation time, fewer complications and therefore consumed fewer resources than anterior fusion surgery. All physicians reported fusion was complete or promising in 100% of the patients studied. SF-36 data demonstrated improvements in physical and mental function which was significant with p=.001 for physical and p=.0344 for mental function. Oswestry questionnaires demonstrated less disability in both groups as compared with ALIF data. Conclusion Through these measures we determined that the PLIP is a good surgery producing a stable fusion with continued nerve root decompression and overall patient satisfaction.


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