Midline Lumbar Fusion for Patients with Adjacent Segmental Disease after Posterior Lumbar Interbody Fusion: A Comparative Study between Midline Lumbar Fusion and Posterior Lumbar Interbody Fusion

Abstract

Objective: This study is a comparative analysis for the radiologic and clinical outcomes of midline lumbar fusion (MIDLF) and posterior lumbar interbody fusion (PLIF) in patients with adjacent segmental disease (ASD) after PLIF. Methods: Thirty patients who met the inclusion criteria were targeted. Of those 30 patients, 10 underwent MIDLF and 20 underwent PLIF. Preoperative and post-operative radiologic outcomes for bone fusion and clinical outcomes for blood loss, operation time and visual analog scale for pain relief were evaluated between the two groups. Postoperative bone fusion status was measured using a 6-point scoring system. Results: Bone fusion was successfully achieved in both groups. The MIDLF group had significantly less blood loss during the operation and shorter operation times than those in the PLIF group (p<0.05). There was a statistically significant interaction between group and time in the mean level of axial pain (p<0.05). Compared to before surgery, axial pain improved in both groups at each postoperative follow up. MIDLF was significantly more effective in the relief of axial pain than PLIF at every postoperative follow up (p<0.05). Conclusion: MIDLF was as effective as PLIF in bone fusion and relief of postoperative axial pain. MIDLF may be a good alternative in patients with ASD after PLIF.