gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Posterior lumbar interbody fusion (PLIF) - Still a treatment option for degenerative lumbar spondylosis? A case control study evaluating clinical and functional outcome

"Posterior lumbar interbody fusion (PLIF)" - immer noch eine Behandlungsoption bei degenerativen lumbalen Spondylosen? Eine Fallkontrollstudie zur Bewertung klinischer und funktioneller Behandlungsergebnisse

Meeting Abstract

  • corresponding author Andreas Bertels - Klinik für Neurochirurgie, Universitätsklinik Düsseldorf, Düsseldorf
  • F. Rommel - Klinik für Neurochirurgie, Universitätsklinik Düsseldorf, Düsseldorf
  • A. Röhrig - Klinik für Neurochirurgie, Universitätsklinik Düsseldorf, Düsseldorf
  • J. Herdmann - Klinik für Neurochirurgie, Universitätsklinik Düsseldorf, Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMI.04.07

The electronic version of this article is the complete one and can be found online at:

Published: April 23, 2004

© 2004 Bertels et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




According to the Cochrane Review ´surgery for degenerative lumbar spondylosis´, an excellent metaanalysis evaluating the whole literature dealing with lumbar spondylosis treatment options up to 12 / 1999, there is no evidence that surgery for lumbar spondylolisthesis leads to better outcome than conservative treatment or natural history. We took this provocative result as a reason to reevaluate the functional outcome of our patients treated with posterior lumbar interbody fusion (PLIF) for degenerative lumbar spondylolisthesis.


From 1996 to 2002 we used a standardized instrumented posterior lumbar interbody fusion technic (HARMS et al.) to treat 41 (male 28 : female 13) consecutive patients (aged 33 - 84 years, mean 59,7 years) for degenerative lumbar spondylolisthesis. Indication for surgery was radiologically proven degenerative spondylolisthesis and instability together with failure of conservative treatment for more than 3 months. Radiological and clinical follow-up was estimated every 3 months. Comorbidity was reevaluated as a prognostic outcome factor, neurological status was estimated pre- and postoperatively according to the FRANKEL score, radiological criteria was used to estimate the fusion rate, a life-quality-score was used to evaluate subjective criteria.


We found a perioperative morbidity of 9,8% including deep wound infections in 3 cases with full recovery, and 1 severe case of persistent neurologic deterioration. There was no postoperative mortality. 1 patient was lost to follow-up. Operation led to the subjective impression of a better quality of life for 73,2% or at least no deterioration for another 12,2%. The rate of objective decrease of neurologic deficits according to the FRANKEL score was low. We found a fusion rate of 73,2%. Though comorbidity was deemed an important outcome factor in other studies it did not play a significant role in our patients.


Objective improvement of neurological deficits following PLIF is low, however there was a markable subjective benefit for more than 70% of our patients. Our objective results support the Cochrane Review. There is no evidence regarding benefits from surgical treatment of lumbar spondylolisthesis but an urgent need for a randomized controlled multicenter study comparing surgical treatment data to natural history of spondylolisthesis.