Role of Posterior Lumbar Interbody Fusion in the Management of Lumbar Instability in Low- and Middle-Income Countries

Authors

  • Mumtaz Ali Ali Institute of Neurosciences, Irfan General Hospital Peshawar.
  • Ramzan Hussain Ali Institute of Neurosciences, Irfan General Hospital Peshawar.
  • Hanif Ur Rahman Ali Institute of Neurosciences, Irfan General Hospital Peshawar.
  • Muhammad Aneeq Ali Institute of Neurosciences, Irfan General Hospital Peshawar.
  • Dr Jabir Shah Ali Institute of Neurosciences, Irfan General Hospital Peshawar.
  • Yasir Ashraf Irfan General Hospital

DOI:

https://doi.org/10.36552/pjns.v28i4.1004

Keywords:

Posterior Lumbar Interbody Fusion, Lumbar Instability, Spine Surgery, Low Back Pain, Neurosurgical Outcomes

Abstract

Objective:  This retrospective observational study aimed to determine the effectiveness of PLIF in the case of lumbar instability using the MacNab Criteria for functional recovery outcomes.

Materials and Methods:  This retrospective observational study included a total number of 21 patients who underwent the PLIF procedure at the Ali Institute of Neuroscience, Irfan General Hospital. Using the MacNab criteria the recovery outcomes of patients were assessed with demographic data and comorbidities recorded. Descriptive statistics including mean, median, and percentages were used to analyze the data, due to the small sample size no advanced inferential statistics tests were conducted.

Results:  The PLIF procedure showed great efficacy in correcting lumbar instability with 85% of patients reporting Good to Excellent recovery outcomes in terms of reduced lower back pain and lumbar instability. Leg pain has been improved in 90% of the cases while 9.5% of cases have reported delayed wound healing and foot drop. Overall, the complication rate was low with the PLIF procedure. These findings determine the effectiveness of PLIF in case of lumbar instability.

Conclusion:  PLIF is a significant surgical option for the correction of lumbar instability with high efficacy and low complication rate especially in low and middle-income countries. Further research with large sample sizes is recommended to show the long-term effectiveness of PLIF and to compare its effectiveness with other fusion techniques.

Author Biographies

Mumtaz Ali, Ali Institute of Neurosciences, Irfan General Hospital Peshawar.

Head Of Department (HOD) Neurosurgery, Ali Institute of Neurosciences, Irfan General Hospital Peshawar. 

Ramzan Hussain, Ali Institute of Neurosciences, Irfan General Hospital Peshawar.

Associate Professor at Ali Institute of Neurosciences, Irfan General Hospital Peshawar. 

Hanif Ur Rahman, Ali Institute of Neurosciences, Irfan General Hospital Peshawar.

Assistant Professor at Ali Institute of Neurosciences, Irfan General Hospital Peshawar. 

Muhammad Aneeq, Ali Institute of Neurosciences, Irfan General Hospital Peshawar.

TMO at Ali Institute of Neurosciences, Irfan General Hospital Peshawar. 

Dr Jabir Shah, Ali Institute of Neurosciences, Irfan General Hospital Peshawar.

TMO at Ali Institute of Neurosciences, Irfan General Hospital Peshawar. 

References

Leone A, Guglielmi G, Cassar-Pullicino VN, Bonomo L. Lumbar intervertebral instability: a review. Radiology. 2007;245(1):62-77.

Lee YP, Sclafani J. Lumbar iatrogenic spinal instability. Semin Spine Surg. 2013;25(2):131-7.

Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol. 2003;13:371-9.

Mohan AL, Das K. History of surgery for the correction of spinal deformity. Neurosurg Focus. 2003;14(1)

Reisener MJ, Pumberger M, Shue J, Girardi FP, Hughes AP. Trends in lumbar spinal fusion—a literature review. J Spine Surg. 2020 Dec;6(4):752-61. doi: 10.21037/jss-20-492. PMID: 33447679; PMCID: PMC7797794.

Montenegro TS, Gonzalez GA, Al Saiegh F, Philipp L, Hines K, Hattar E, Franco D, Mahtabfar A, Keppetipola KM, Leibold A, Atallah E, Fatema U, Thalheimer S, Wu C, Prasad SK, Jallo J, Heller J, Sharan A, Harrop J. Clinical outcomes in revision lumbar spine fusions: an observational cohort study. J Neurosurg Spine. 2021 Aug;35(4):437-45. doi: 10.3171/2020.12.SPINE201908.

Liu X, Wang Y, Qiu G, Weng X, Yu B. A systematic review with meta-analysis of posterior interbody fusion versus posterolateral fusion in lumbar spondylolisthesis. Eur Spine J. 2014 Jan;23(1):43-56. doi: 10.1007/s00586-013-2880-8. PMCID: PMC3897839; PMID: 23812825.

Said E, Abdel-Wanis ME, et al. Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Global Spine J. 2021 May;12(5):789-799. doi: 10.1177/21925682211016426.

Cunningham JE, Elling EM, Milton AH, Robertson PA. Optimum fusion technique for adult isthmic spondylolisthesis—PLIF or PLF? A long-term prospective cohort comparison study. J Spinal Disord Tech. 2013 Jul;26(5):260-7. doi: 10.1097/BSD.0b013e3182417103.

Rathbone J, Rackham M, Nielsen D, Lee SM, Hing W, Riar S, et al. A systematic review of anterior lumbar interbody fusion (ALIF) versus posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), and posterolateral lumbar fusion (PLF). Eur Spine J. 2023;32:1911–26. doi: 10.1007/s00586-023-07469-4.

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Published

2024-12-21

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Original Articles