Does functional outcome mandate fusion in spondylolisthesis management? A retrospective analysis of 76 cases with one year follow-up

Abstract

Introduction: Lumbar spondylolisthesis is a common condition in the middle-aged population that causes significant morbidity. In the management of spondylolisthesis, spinal fusion with instrumentation has been the standard of care. This study aimed to analyze whether fusion is a necessary component for achieving an optimal functional outcome in the management of spondylolisthesis. Materials and Methods: This is a retrospective study involving 76 patients who underwent a transforaminal lumbar interbody fusion with a minimum follow-up of one year. Parameters assessed were preoperative pain score with VAS, functional ability with ODI, radiological outcome with reduction of slip grade, slip angle, and lumbar lordosis improvement. MacNab’s criteria for functional outcome and Lee’s criteria for fusion were utilized. Statistical analysis was performed with students’ paired t-test and Pearsons’ correlation analysis. Results: Improvement in VAS and ODI was noted as 8.2 to 2.1 and 72 to 14 respectively. Slip angle improved from 240 to 6o and 78% of the patients showed radiological fusion and 89% showed good clinical outcomes at 1-year follow-up. Correlation analysis showed no significant correlation between the pain scores and radiological fusion parameters analyzed (r=0.142, p=0.361). However, a significant correlation was noted between the fusion group and functional outcome parameters like the ODI score (r=0.34, p Conclusion: TLIF ensures successful fusion in spondylolisthesis patients. Spina fusion is a necessary prerequisite for a successful functional outcome in spondylolisthesis patients undergoing TLIF. Slip angle reduction is not mandatory in all patients of lumbar spondylolisthesis. Keywords: Fusion, Spondylolisthesis, TLIF, PLIF, Interbody Fusion, Spine.