Posterior Fixation with Transforaminal Lumbar Interbody Fusion for Single Level Isthmic and Degenerative Lumbar Spondylolisthesis in Adults Causes Less Complication

Abstract

BACKGROUND
 Lumbar interbody fusion has long been considered the "gold standard" technique for surgical treatment of adult spondylolisthesis. Superior results have subsequently been reported with interbody fusion with cages and posterior instrumentation. The objectives of the study were to determine the functional outcome after one year following surgery and evaluate the fusion rate.
 METHODS
 In this prospective, non-randomised study, 26 patients (average age 37.1 yrs) with isthmic spondylolisthesis (IS), who suffered for an average of 12.08 months and 14 patients with degenerative spondylolisthesis (DS) (average age 58.6 yrs), who suffered for 13.2 months on average were collected in out-patient department basis. They underwent an interbody fusion with cages with posterior instrumentation (TLIF or PLIF). Clinical outcome was measured using VAS and Oswestry Disability Index. Foraminal dimensions and disc heights were measured in standard digital radiographs. Radiographic fusion was confirmed with CT scans at 1 year.
 RESULTS
 In the IS group, a mean spondylolisthesis slip of 33.3 % was reduced to 6.7 % at 1 year. Vertical foraminal distance(C) was improved from 11.2 mm to 12.0 mm. The fusion rate was 78.2 % with TLIF and 66.7 % with PLIF. In the DS group, a mean spondylolisthesis slip of 32.7 % was reduced to 7.4 % at 1 year. C distance was improved from 11.8 mm to 13.2 mm. The fusion rate was 66.7 % with TLIF and 100 % with PLIF. The mean ODI scores at baseline and 1 year, were improved from 48 to 9.8 and from 49.5 to 18.4 in the IS and DS groups respectively. VAS score was improved from 6.4 to 0.8 and from 6.6 to 2.5 in IS and DS groups respectively.
 CONCLUSIONS
 Interbody fusion for low-grade spondylolisthesis requiring reduction results in excellent to good functional outcomes in 90 % of patients with a good fusion rate. TLIF procedure of spinal fusion requires less time, causes less bleeding, and has less chance of damage to the neural structures than PLIF.