Resumo

OLIVEIRA, Vânia et al. Estudo comparativo da artrodese posterolateral e PLIF no tratamento da espondilolistesis degenerativa grau I ou II ? análise de 124 casos. Rev. Port. Ortop. Traum. [online]. 2014, vol.22, n.1, pp.34-46. ISSN 1646-2122.

Aim: Posterolateral arthrodesis (PLA) and Posterior Lumbar Interbody Fusion (PLIF) are valid surgical techniques for degenerative spondylolisthesis. Biomechanical stress in the adjacent fusion level accelerats degenerative changes. In literature the most appropriate treatment is still debatable. This comparative study evaluates clinical outcome, fusion rate, complications and adjacent level disease. Material and Methods: Retrospectively were analysed the Meyerding grades I and II degenerative spondylolistheses treated by PLIF or PLA between January 2000 and December 2010, in a total of 124 patients, 45 PLIF and 79 PLA. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and 36-Item Short-Form General Health Survey (SF-36) were used. PLIF fusion was determined if stableshement of stable trabecular bony bridges. Instability in PLA was defined when adjacent screws osteolysis, sliding or angulation at the fusion level. Results: The follow-up was 4.5±2.7 and 3.9±2.6 years (range 1-11 years) in PLIF and PLA, respectively. There was 93.3% PLIF fusion and 74.7% PLA (p=0.008). PLIF had superior VAS postoperatively (p=0.01) and overall decrease (p=0.002). Postoperative PLIF ODI was lower (p<0.001) and 2.2% remained with severe disability compared to 19% in PLA. The PLIF SF-36 was higher in Physical Functioning (p=0.034), Role-Emotional (p=0.037), Social Functioning (p=0.05) and General Health (p=0.02) scales. The complications rate was 4.4% in PLIF and 12.6% in PLA (p=0.2). Adjacent disc disease developed in both techniques. Conclusions: In both groups there was quality of life improvement but long-term PLIF has superior effective arthrodesis. Pre-operative instability may be indicative for PLIF election.

Palavras-chave : Arthrodesis; lumbar; fusion; degenerative spondylolisthesis; PLIF; instability; intervertebral disc; adjacent segment disc disease.

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