Study design: A retrospective review of prospectively collected data.
Objective: The aim of this study was to compare quality of life (QOL) outcomes of posterior lumbar interbody fusion (PLIF) with lateral lumbar interbody fusion (LLIF) using reports from patients obtained at the 2-year postoperative follow-up.
Summary of background data: Indirect decompression with LLIF is used to treat degenerative lumbar diseases that require neural decompression. However, the difference in improvement in QOL following indirect decompression compared with direct neural decompression using PLIF is unclear.
Methods: We enrolled 284 consecutive patients with degenerative lumbar spondylolisthesis in the present study, 203 who underwent PLIF and 81 who underwent LLIF. All patients completed a minimum of 2 years of follow-up. We evaluated the effectiveness of surgery in each category of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ).
Results: The results of preoperative JOABPEQ and the severity of thecal sac stenosis were not significantly different between PLIF and LLIF, neither was the rate of perioperative complications (14.8% and 15.4% for the PLIF and LLIF groups, respectively; P = 0.91). The effectiveness at 2 years postoperatively was almost the same for all five domains of the JOABPEQ: 62.6% and 68.9% for pain-related disorders (P = 0.34), 38.3% and 42.7% for lumbar spine dysfunction (P = 0.51), 65.8% and 67.5% for gait disturbance (P = 0.79), 53.5% and 48.8% for social life dysfunction (P = 0.47), and 29.1% and 33.3% for psychological disorders (P = 0.48) following PLIF and LLIF, respectively. Visual analogue scale results for back and lower-limb pain and numbness of the lower limbs were almost the same for both groups. No significant differences were observed in terms of perioperative complications and radiographical outcomes.
Conclusion: Indirect decompression using LLIF improves QOL and radiographical outcomes to a comparable degree as direct decompression via PLIF.
Level of evidence: 4.