Surgical treatment of degenerative lumbar spine instabilities by short internal fixation and posterior lumbar interbody fusion (PLIF) in 107 cases

Meisel HJ¹

Kern C. B.¹, Beier A.¹, Foltys  E.¹, Ramsbacher J², Mansmann U³

BG-Kliniken Bergmannstrost, Halle, Germany

Merseburger Str. 165, 06112 Halle

Objective: To report the results of posterior lumbal interbody fusion (PLIF) in 107 consecutive patients who experienced claudication, leg pain and motosensory deficit caused by degenerative lumbar instability.

Methods: 60 (56,1 %) female and 47 (43,9 %) male with the mean age of 58.1 years and the mean weight of 75.4 kg underwent surgery for mono (m =93 (86.9 %)) or bisegmental (n=14 (13,1 %)) degenerative spondylolisthesis. Posterior decompression thought laminectomy (37,4 %) or by lateral fenestration (62,6 %) with partial facettectomy was followed by dual intervertebral titanium cage implantation and posterior internal fixation. The titanium cages were filled with autologous corticospongiosa. Claudication, pain and motosensory deficit were assessed using pre- and postoperative (1 m, 9 m, 2 y) the Beaujon score (20 - 0 points). Additionally disability was determined by the Wadell score (0 - 9 points)

Results: The Beaujon score increased from 7.6 to 13.7 in the first month postoperativly (p<0,001) from 7.4 to 14.2 in 6 month after surgery (p<0,001) and from 7.5 to 15.0 within 2 years (p=0,042).The Wadell score improved from  4.9 to 2.9 (p<0,001) in the first month from 5.2. to 1.9 (p<0,001) in 6 month. Improvement in both scans was significant (p<0,001) under Paired-T-Test as well as Wilcoxon signed Rank-Test. Statistical assessment of improvement over time (One-Sample-Test) show a mean increase of 6.8  per month postoperativly in the Beaujon score (p<0,001) and a mean decrease of 3.4 per month in the Wadell score (p<0,001).

Conclusion: Posterior lumbar interbody fusion (PLIF) with internal fixation and posterior decompression in the treatment of degenerative lumbar instabilities show reduction of neurological deficit, pain and claudication and improvement of the patients quality of life.

Key words: PLIF, posterior lumbar interbody fusion, titanium cages, spondylolisthesis, segmental spinal instability