Comparison of Results of 4 Methods of Surgery in Grade 1 Lumbosacral Spondylolisthesis

Abstract

Introduction: There are 3 ways for the treatment of patients for spondylolisthesis grade 1 in lumbosacral region associating with lumbar disk herniation or lumbar stenosis: pedicular screw fixation method alone; pedicular screw with insertion of trans lumbar interbody fusion (TLIF), or with posterior lumbar interbody fusion (PLIF). Interestingly, all methods have associated with satisfactory results. However, which method is superior for the treatment of such patients still has remained controversial. Materials and Methods: Patients with clinical signs and symptoms of disk herniation or lumbar canal stenosis and also spondylolysthesis grade 1 were selected, who had randomly undergone pedicle screw and posterior fusion surgery, pedicle screw and TLIF surgery, pedicle screw and PLIF surgery, or without instrumentation and fusion, in neurosurgery section in Mashhad, from 2009 to 2011. Afterwards, clinical symptoms, radiologic study results, amount of fusion in terms of Brantigan and Stefee indices, and functional improvement by Oswestry Disability Index were recorded after 6 and 12 months from surgery, respectively. Results: Of 120 patients who were analyzed in 4 treatment groups, age and sex distribution was matched. Also, L4-L5 involvement was more common in 3 groups with a normal distribution. Statistically, Oswestry Disability Index had a significant reduction after operation, and no significant differences were observed among the 3 study groups. These groups showed no significant variation in degree of fusion and Brantigan and Stefee index, but in the group which had been undergone surgery without instrumentation and fusion, the difference was significant. Conclusions: After a 12-month follow-up, the 3 procedures of TLIF, PLIF, and posterior fusion pedicle screw did not show any difference in functional improvement of the patients, degree of fusion, and complications significantly, whereas all of them had a significant preference rather than the fourth group, in which no instrumentation and fusion was applied.