Clinical and functional outcome analysis of posterior decompression and spinal fusion surgery in the management of lumbar and sacral listhesis: A prospective cohort study

Abstract

Introduction: Spondylolisthesis resulting in low backache, radiculopathy, and neurological involvement is a very common clinical entity. Conservative and surgical managements are available for the treatment of spondylolisthesis. Cases with severe instability and neurological deficits that cannot be managed conservatively may require surgical intervention. According to the SPORT trial, posterior decompression and spinal fusion was found to be an effective treatment modality. The present study was undertaken with an aim to understand the functional and clinical effects of posterior decompression and spinal fusion at lumbosacral region in patients with listhesis. Purpose: The purpose of this study is to evaluate the clinical and functional outcomes of listhesis at lumbar and sacral region managed by posterior decompression and spinal fusion. Methods: This was a prospective randomized study involving patients above 18 years, having low backache with or without sciatica, and having neurological deficits. Listhesis was diagnosed clinically and on stress radiograms and magnetic resonance imaging. All patients who fit the inclusion criteria underwent posterior decompression and if needed spinal fusion for symptomatic management. Results: A total of 30 patients participated in this study, with 73.33% women and the rest 26.67% men (mean age 51.37 ± 12.70 years). The most commonly affected level was L4–L5 along with L5–S1 right below it. Out of 30 patients, three underwent posterior decompression and fixation without fusion while one was managed with laminotomy and discectomy. The remaining patients were managed with posterior decompression and intervertebral fusion which was mainly at the L4–L5 level. At 6 months of follow-up, the mean preoperative visual analog scale score which was 8.70 ± 0.83 was reduced to 1.53 ± 1.38 along with appreciable reduction in Japan Orthopedic Association and Oswestry index scores. Three patients had surgical site infections while one patient had no pain relief. Conclusion: Posterior decompression and spinal fusion is an effective way in the management of lumbosacral listhesis.