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Three Spinal Fusion Methods Compared

In this study three methods of posterior spinal fusion were compared. Fusion is designed to restore spinal stability or rigidity after bone has been removed in an operation called decompression. Decompression takes pressure off the nerves as they leave the spinal canal. The goal is to relieve back and leg pain.

The authors describe each operation and mention advantages of each one. The three operations included:
1) Posterolateral fusion (PLF)
2) Posterior Lumbar Interbody Fusion (PLIF)
3) PLF combined with PLIF (PLF + PLIF)

Patients with degenerative lumbar disease were randomly placed in one of these three groups. A total of 167 patients were fused at one or two levels. Patients were followed for at least three years.

The authors report there was no difference in results among the three groups. At least 80 per cent and as many as 88 per cent of the patients reported good or excellent results. Success was measured based on improvement in symptoms, function, and disability. X-rays were taken to show the disc heights and fusion sites.

Problems such as nonunion, infection, and nerve damage occurred in all three groups at about the same rate (four to eight per cent). The three methods compared have equal results but slightly different advantages and disadvantages. PLF + PLIF gives a solid fusion. Fusion rates were slightly less with PLF alone. PLIF alone has the advantage of a shorter operation, less blood loss, and no bone graft donor site pain.

References: Ki-Tack Kim, MD, et al. Clinical Outcomes of 3 Fusion Methods Through the Posterior Approach in the Lumbar Spine. In Spine. May 20, 2006. Vol. 31. No. 12. Pp. 1351-1357.

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