COMPARISON OF OUTCOMES IN PLIF SURGERY IN RELATION TO PATHOLOGY

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COMPARISON OF OUTCOMES IN PLIF SURGERY IN
RELATION TO PATHOLOGY
www.spinalunit.org
Manoj Krishna Chandra Bhatia Raymond Pollock
Spinal Unit, University Hospital of North
Tees, Stockton-on-Tees. UK.
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• There are few effective treatment alternatives
  available for Post-discectomy syndrome

Braverman et al, Archives of Physical Medicine
and Rehabilitation 82(5), 691-93, 2001 May
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• Only 34 improvement in post-discectomy patients
  having surgery

North et al Neurosurgery, 28(5) 685-690, 1991
May
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• Do patients with Postlaminectomy or
  Postdiscectomy surgery have poorer outcome as
  compared to other groups after revision surgery?

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PATIENT SAMPLE

• Prospective study
• 154 Patients
• 85 Female, 69 Male
• Mean Age - 44.3 years (Range 12-81)
• Minimum follow-up- 2 years
• All failed conservative treatments

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PATIENT SAMPLE

• Degenerative Disc Disease-114
• Post discectomy syndrome- 30
• Spondylolysis/listhesis- 10

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Principles of PLIF/TLIF Surgery

• Remove Pain Generators- Disc/Facet
• Free Neural Structures
• Restore Normal Loading through Disc

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OUTCOME MEASURES USED

• Oswestry Disability Index
• Visual Analog Scale for Back Pain
• Visual Analog Scale for Leg Pain

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Statistical Methods

• Normality of data set checked
• Paired t test in each group
• ANOVA used to test difference between the mean
  improvements of the 3 groups

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CHANGES IN ODI
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Improvement in ODI
No statistical difference between the 3 groups(
p0.494)
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CHANGES IN VAS FOR LBP
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Improvement in VAS Back Pain
No statistical significant difference between the
3 groups(0.38)
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CHANGE IN VAS FOR LEG PAIN
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Improvements in VAS Leg Pain
No statistical difference between the 3
groups(p0.639)
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Summary

• PLIF surgery results in clinical and
  statistically significant improvements in
  patients with DDD, Post-discectomy syndrome, and
  Spondylolisthesis
• There was no statistical difference between these
  3 groups in the amount of improvement

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Trends

• Leg pain improvement in post-discectomy group,
  though significant, is less than other groups
• ODI improvement in spondylolisthesis group is
  more than other groups

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Discussion

• Challenges current thinking that patients with
  post-discectomy syndrome do poorly after surgery(
  and nothing can be done for them)
• Suggests that improvements in the post-discectomy
  group are comparable to primary surgery

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Discussion

• Literature suggests type of surgery influences
  outcome, with repeat decompression the least
  beneficial
• PLIF addresses all the pathology in the motion
  segment

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• Thank You

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