DOS BULLETIN - Dansk Ortopædisk Selskab

2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 134
A prospective randomized trail between Transforaminal
(TLIF) and instrumented posterolateral fusion
(PLF)
A one year follow- up
Kristian Høy, Bent Niederman, Peter Helmig
Aarhus University Hospital, Orthopedic Department E
Background: Circumfentrical fusion is superior to PLF concerning functional
outcome, fusionrate and saggital balance, Christensen 2002, Videbaeck
2006.Need of anterior support was questioned 2007 Ekman, comparing
PLIF/PLF. In 2009 Neumann compared TLIF to PLF,outcome was significantly
in favor of TLIF.
Purpose: The aim of the present study was to show whether these benefits also
could be found in a Transforaminal interbody fusion group (TLIF) compared to a
normal posterolateral fusion group (PLF). Since TLIF theoretical implicate the
benefits of 360 degrees fusion, by less invasive surgery, and thereby less morbidity.
Methods: During 01.11.2003-.01.11.2008 100 pt`s were prospectively randomized
to either Transforaminal instrumented fusion or Postero lateral instrumented
fusion. The TLIF group was operated using TSRH(Medtronic)and Implex (Zimmer)
and allograft. The PLF group was operated using TSRH (Medtronic) and
allograft. Inclusions criteria were patients with segmental instability due to disc
degeneration, former disc herniation, spondylolisthesis less than grade 2. All
patients functional outcome was registered prospectively, and after one year using
Dallas Pain questionnaire (DPQ), SF-36, and Low Back pain questionnaire.
Findings: Sex ratio 40 men and 58, women. 51 patients had TLIF and 47 PLF.
Mean age TLIF/PLF was 49/45. No statistic difference in outcome between the
two groups at one year could be detected, concerning, daily activity, work leisure,
Anxiety/depression, social interest. No statistical difference could be seen
between groups concerning Back pain or Leg pain. Boths groups had significant
improvement in functional outcome, back pain, and leg pain after one year compared
to preoperative. Daily activities p > 0.0002/0.00001, Back pain >
0.00001/0.00001, Leg pain > 0.0007/0.0002. Operation time in the TLIF group
was significant higher p < 0.00001, mean 228 min TLIF group, 180. min PLF
group The blood loss was significantly higher in the TLIF group compared to the
PLF group p > 0.0011 mean 776 ml (TLIF), 437 ml (PLF). No difference in radiological
fusion after one year. Patients satisfaction after 1 year was, 75 percent
overall,, 78 % (TLIF), 73 %(PLF).
Conclusion: Spinal fusions significant improve patient`s Functional outcome,
Back Pain and Leg pain after one year. No statistical significance difference in
functional outcome, Back or Leg pain could be found between Transforaminal
group and Posterolateral fusion group after one year.
134