Long term follow-up of patients undergoing Posterior Lumbar

Interbody Fusion (PLIF) SurgeryA review of 182 cases

Manoj Krishna Raymond Pollock

Chandra BhatiaSpine unit, University Hospital of North TeesStockton-on-Tees

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Methods• Study period March 1997 to November 2003• 226 patients underwent PLIF• 182 patients have both baseline & follow-up

(80% response)• Outcomes measured at baseline (pre-op) and at

a single follow-up (post-op)• Mean follow up – 26 months

Spine unit, University Hospital of North TeesStockton-on-Tees

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Outcome Measures

• Oswestry disability index (ODI)*• VAS for back and leg pain• SF-36

*9 section NASS ODI used, with each section scored 0-5 www.spinalunit.org.

Patients• 182 patients

– 99 females– 83 males

• Mean age = 45.3 yrs• 110 one level fusion• 72 two level fusion• Duration of

symptoms- median 63 months

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17.1%Spondylo

14.5%Postlamin

5.3%DProlapse 63.2%

DDD

Diagnosis of Patients Undergoing PLIF

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52.9

29.1

0

10

20

30

40

50

60

Baseline Follow-up

Osw

estry

Dis

abili

ty In

dex

t-test P = 0.001

95% CI for difference (23.8) = 18.4 – 29.2

Outcomes: ODI

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Outcomes: VAS scores7.7

6.6

3.8 3.2

0

2

4

6

8

10

Back Leg

VAS Pain Score

Baseline

Follow-up

t-test back pain P = 0.00195% CI for difference (3.9) = 3.2 – 4.8

t-test leg pain P = 0.00195% CI for difference (3.3) = 2.0 – 4.3

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SF-36 Scores

Dimension Improvement % P valuePF 69 0.001BP 68 0.001GH 16 0.001VT 48 0.001SF 43 0.001MH 12 0.022RE 14 0.006RP deteriorated

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Summary

• ODI- 45% improvement

• VAS Back- 51% improvement

• VAS Leg- 50% improvement

• SF-36- 12-69% improvement

Complications

• Dural tear- 12 • Neuralgia- 16→ 6 persistent leg pain• Infection-

– Superficial-8, Deep-2.• Bone graft pain- 3• Pedicle fracture- 2• Brachial neuropraxia- 1

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Clinical Results

• 68% of patients had significant improvement in Oswestry scores (>15%).

• 79% of patients had significant decrease in VAS for Back pain (change >2 points).

• 68.3% of patients had significant decrease in VAS for leg pain (change>2 points).

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Conclusion

PLIF surgery reduces pain, improves functioning and quality of life in patients with chronic low back & leg pain, unresolved by

conservative therapy

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Further Advancement

• Our current technique involves less invasive surgery and results are much better than the results presented.

• We will present these results in a future meeting.

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THANK YOU

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