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KMID : 0388720110180030132
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Journal of Korean Society of Spine Surgery
2011 Volume.18 No. 3 p.132 ~ p.139
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Comparative Study of Posterior Lumbar Interbody Fusion with Posterolateral Fusion in Degenerative Lumbar Spinal Disorders
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Lee Jin-Young
Kang Jung-Woo
Park Hyun-Tai
Song Kyung-Won
Shin Sung-Il
Kim Gab-Lae
Hyun Yoon-Suk
Lee Jeong-Gil
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Abstract
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Study Design: A retrospective study.
Objectives: The authors found that problems such as axial pain, donor site pain, loss of reduction, loosening or failure of fixation materials occurred relatively frequently after posterolateral fusion. For this, we had views on the ideas that the problems could be improved by an operation that fused vertebral bodies. Furthermore, we performed posterior lumbar interbody fusion and wanted to know the results.
Summary of the Literature Review: We performed posterior lumbar inter-body fusion as an alternative, due to complications of autoiliac bone graft that has complications, such as donor site pain.
Materials and Methods: Sixty patients with single segment degenerative lumbar disease were treated with decompression, pedicle screws fixation, and spinal fusion. The patients were followed-up for more than 2 years. Thirty patients, who had undergone posterolateral fusion with autologous iliac bone graft, were classified as the "group 1". The second 30 patients, who underwent posterior lumbar interbody fusion with cage and local bone graft, were classified as the "group 2". The operation time, blood loss, fusion rate, lumbar lordotic angle, segmental angle were compared between the 2 groups. The clinical outcomes were evaluated by Kim’s functional evaluation scale.
Results: The operation time was shorter in group 2 (142.74 minutes vs 171.64 minutes), there was a statistical difference between the 2 groups. Intraoperative blood loss was more in group 2 (563.40 vs 551.78 mL), but total blood loss, including postoperative drained blood was less in group 2. The bony fusion rate was 90% in group 1, 97% in group 2. For the lumbar lordotic angle, the last outcome was less than the preoperative value. There was no statistical difference between the 2 groups. The segmental angle in group 1, the last outcome was less than the preoperative value. The segmental angle in group 2 was maintained the value through pre-operation to post-operation. Clinical outcomes were satisfactory in group 1 (96.67%) & in group 2 (100%). In group 1, 7 patients experienced pain at the iliac graft donor site. In group 2, there were 2 cases of retroposition of the cage.
Conclusions: In the posterior lumbar interbody fusion group, operation time was shorter, total blood loss was less than in the posterolateral fusion group. Restoration and maintenance of the segmental angle in sagittal and coronal radiographs showed better outcomes, axial pain and iliac donor site pain were less. It is the authors’ position that posterior lumbar interbody fusion is an alternative operation to supplement the faults of posterolateral fusion.
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KEYWORD
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Degenerative lumbar spinal disorders, Posterior lumbar interbody fusion, Posterolateral fusion
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