• Seiji Ohtori, Takana Koshi, Masaomi Yamashita, Masashi Takaso, Kazuyo Yamauchi, Gen Inoue, Munetaka Suzuki, Sumihisa Orita, Yawara Eguchi, Nobuyasu Ochiai, Shunji Kishida, Kazuki Kuniyoshi, Yasuchika Aoki, Tetsuhiro Ishikawa, Gen Arai, Masayuki Miyagi, Hiroto Kamoda, Miyako Suzuki, Junichi Nakamura, Takeo Furuya, Tomoaki Toyone, Masatsune Yamagata, and Kazuhisa Takahashi.
• Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. sohtori@faculty.chiba-u.jp
• J Orthop Sci. 2011 Jul 1;16(4):352-8.

BackgroundSurgery for lumbar spondylolisthesis is widely performed. However, there have been no reports comparing posterolateral and anterior interbody fusion prospectively. We compared instrumented posterolateral fusion with anterior interbody fusion for L4 spondylolisthesis in a prospective study.MethodsForty-six patients diagnosed with L4 degenerated spondylolisthesis were divided into two groups. Twenty-two consecutive patients underwent non-instrumented anterior interbody fusion using an iliac bone graft (ALIF; L4-L5 level), and 24 consecutive patients underwent instrumented posterolateral fusion with local bone (PLF; L4-L5 level). The rates of bone union, visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score, Oswestry Disability Index (ODI), surgical invasion, and complications were evaluated before and 2 years after surgery.ResultsAge, VAS score, JOA score, and ODI were not significantly different between the two groups before surgery (P > 0.05). Success of bone union between the two groups was not significantly different (P > 0.05). Blood loss during surgery was significantly less; however, periods of bed rest and hospital stay were significantly longer in the ALIF group (P < 0.05). Overall patient satisfaction, and low back and leg pain in both groups were significantly improved after surgery; however, low back pain showed greater improvement in the ALIF group compared with the PLF group (P < 0.05). Complications such as donor site pain (4 patients in the ALIF group) and dural tearing (3 patients in the PLF group) were observed.ConclusionsIf single level fusion for L4 spondylolisthesis is performed, both anterior and posterior methods reduce patients' low back and leg pain. Improvement of low back pain was significantly greater after ALIF; however, periods of hospital stay and of bed rest were significantly longer.

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