Clinical, Functional and Radiological Outcome of Posterior Lumbar Interbody Fusion by Banana Cage with Bone Graft for the Treatment of High-grade Lumbar Spondylolisthesis at L5-S1

Abstract

Objectives: To assess the clinical, functional and radiological outcome of posterior lumbar interbody fusion (PLIF) by Banana cage with bone graft. Material and Methods: This retrospective analytical study was carried out in spine unit of Orthopaedic surgery department of BSMMU, and other private hospital in Dhaka from January 2010 to December 2020. We did PLIF by Banana cage with bone graft for High-grade Lumbar Spondylolisthesis at L5-S1. The follow-up period ranges from 1- 2 years (average 18 months. All patients were assessed by VAS, ODI, WDI, Spino-pelvic parameters, Modified Macnab’s Criteria to find out overall outcome and Hackenberge ctriteria for radiological fusion. Results: Total 40 patients were included among 16 were male and 24 were female. The average age of the patients was 52.45±10.1 years. 60.0% patients were housewife ,20.0%, 10.0%, 10% were day laborer, farmer and service holder respectively. Average pelvic tilt was 26.05±6.27° preoperatively and 24.10±6.26° at the final follow-up, average PI was 66.07±7.39° preoperatively and 61.19±7.08° at the final follow-up. Preoperative lumbar lordosis was 45.55± 6.71° & at final follow-up 37.29±6.19°. VAS score and ODI scales were improved significantly from preoperative 6.90 ± 6.16 and 57.60±15.66 to at final follow-up 2.0±0.8 and 7.60±2.40. Pre-operative Translation ratio, slip angle and disc height ratio were 21.96±10.25, -18.87±8.28, 11.03±4.36 and at postoperatively 13.17±6.57, -18.44±7.12, 19.60±3.36. Fusion was achieved in 36 cases (90%), 3 cases (7.5%) were fragmented and pseudoarthrosis showed only 1 case (2.5%). Post-operative clinical outcome showed excellent outcome (95%), 1 (2.5%) case had good and 1 (2.5%) case had fair outcome. Conclusion: It can be concluded that, PLIF by Banana cage with bone graft is a very good option for the treatment of High-grade Lumbar Spondylolisthesis at L5-S1 levels. Keywords: Posterior Lumbar Interbody Fusion, High-grade Spondylolisthesis, Visual Analogue Score, Oswestry Disability Index, Waddell disability index, Hackenberge criteria, Pelvic parameters.