Comparison of Clinical Efficacy in the Treatment of Lumbar Degenerative Disease: Posterior Lumbar Interbody Fusion, Posterior Lumbar Fusion, and Hybrid Surgery.

Abstract

Background: Numerous studies have confirmed that both posterior lumbar interbody fusion (PLIF) and posterior lumbar fusion (PLF), have their advantages and disadvantages. However, the inconsistent results of these studies make it difficult to reach a consensus on which fusion method is superior.

Objective: To compare the clinical outcomes of PLIF, PLF, and hybrid surgery combining PLIF and PLF in the treatment of lumbar degenerative disease.

Methods: A retrospective review was conducted, collecting clinical records and radiological data of patients with lumbar degenerative disease from 2014 to 2022. Patients were divided into 3 groups based on surgical strategy: PLIF group, PLF group, and hybrid group. Clinical data included patient-reported outcomes such as the Japanese Orthopedic Association score, Oswestry Disability Index score, visual analog scale score, 36-item Short Form Health Survey score, and the occurrence of complications. Radiological data included Cobb angle, fusion rate, adjacent segment degeneration (ASDeg), adjacent segment disease (ASDis), and cage subsidence.

Results: A total of 378 patients were divided into 3 groups: PLIF group (n = 122), PLF group (n = 126), and hybrid group (n = 130). The baseline characteristics were balanced among the 3 groups. As the follow-up time increased, visual analog scale scores showed varying degrees of improvement (all P _{measure time} < 0.001), but there were no significant differences observed between the groups (all P _{measure time * group} > 0.05). Oswestry Disability Index scores improved over time (F _{measure time} = 939, P _{measure time} < 0.001), with the hybrid group showing more significant improvement (F _{measure time * group} = 2.826, P _{measure time * group} = 0.006). The 36-item Short Form Health Survey scores and Cobb angles also improved significantly during the follow-up period, with no significant differences observed among the groups. The overall fusion rates for the hybrid group and PLIF group were 93% and 91%, significantly higher than the fusion rate of the PLF group (84%; P = 0.031). The postoperative complication rate was significantly higher in the PLIF group (24.4%) compared with the PLF group (16.4%) and the hybrid group (12.5%; P = 0.022). There was no significant difference in the overall 5-year ASDeg occurrence rate (38% vs 36%) and ASDis occurrence rate (11.3% vs 8.3%) between the PLIF group and PLF group for single-level fusion (P > 0.05). The occurrence rate of ASDeg for multilevel fusion in the hybrid group was 29%, significantly lower than that in the PLIF group (42%) and PLF group (37%; P = 0.044). The overall 5-year ASDis occurrence rates for multilevel fusion were 12.3%, 9.9%, and 7.6% for the PLIF group, PLF group, and hybrid group, respectively, with no significant statistical difference (P = 0.338).

Conclusion: All 3 surgical techniques might improve the clinical symptoms of patients with degenerative lumbar disease effectively. The hybrid technique demonstrated comparable efficacy to PLIF and PLF in increasing fusion rate, reducing complications, and decreasing the occurrence of ASDeg in multilevel fusion cases significantly.

Clinical relevance: This study holds significant clinical relevance as it directly addresses the treatment outcomes of common surgical interventions for lumbar degenerative disease, a condition that significantly impacts patient quality of life and functionality. This study is also crucial for clinicians when selecting the most appropriate treatment strategy for patients with lumbar degenerative disease.

Level of evidence: 3: