Abstract
BackgroundContiguous double-level lumbar spondylolytic spondylolisthesis is an extremely rare condition. There is a paucity of data of lumbosacral deformity and sagittal spino-pelvic malalignment among these patients. Moreover, the effect of transforaminal lumbar interbody fusion (TLIF) on sagittal realignment still remains largely unknown. The aim of the study is to investigate the reconstruction of sagittal alignment and the improvement of clinical outcomes after posterior instrumented double-level or single-level TLIF.MethodsFrom January 2010 to September 2018, the records of patients with contiguous L4/5 and L5/S1 double-level spondylolytic spondylolisthesis were retrospectively reviewed. Patients who had undergone double-level or single-level TLIF and a minimum of 2 years’ follow-up were included. The slippage parameters and spino-pelvic parameters were measured preoperatively, postoperatively, and at the latest follow-up.ResultsA total of 58 patients (21 males and 37 females, mean age of 57.1 ± 6.9 years) were enrolled. Thirty-eight patients were treated with double-level TLIF and the remaining 20 with single-level TLIF (L4/5 in 14; L5/S1 in 6). After surgery, the spondylolisthesis was significantly reduced at both L4/5 and L5/S1 level (all P < 0.001). There was a significant reduction in pelvic tilt (P < 0.001) and a significant increase in sacral slope (P < 0.001). Significant increase in L4–S1 height (P < 0.001) and L4–S1 lordosis (P = 0.012) and decrease in L5 slope (P = 0.004) and L5 incidence (P = 0.001) were also observed. Compared to single-level TLIF, double-level TLIF increased L4–S1 height (P < 0.001) and L4–S1 lordosis (P < 0.001) and reduced L4-SVA (P = 0.007) and L5 incidence (P = 0.013) more obviously, and the sagittal balance was better corrected in double-level TLIF group (P = 0.006). Double-level TLIF group showed larger increase in VAS scores for low back pain. The incidence of implant-related complications was lower in the double-level group.ConclusionPosterior short-segment instrumented TLIF can bring favorable radiographic and clinical outcomes in patients with lumbosacral contiguous double-level spondylolytic spondylolisthesis. Double-level TLIF is more efficient to improve L4–S1 height, regional lumbar lordosis, and global sagittal balance.
Highlights
Lumbosacral contiguous double-level spondylolytic spondylolisthesis is an extremely rare condition with an incidence of 0.3–1.48% [1, 2]
The present study reviewed the medical records of a consecutive series of patients with lumbosacral contiguous double-level spondylolytic spondylolisthesis who had been treated with posterior instrumentation and transforaminal lumbar interbody fusion (TLIF)
The double-level TLIF group was composed of 15 males and 23 females with the mean age of 54.4 ± 9.4 years), while the single-level TLIF group consisted of 6 males and 14 females with the age of 58.2 ± 5.7 years
Summary
Lumbosacral contiguous double-level spondylolytic spondylolisthesis is an extremely rare condition with an incidence of 0.3–1.48% [1, 2]. Transforaminal lumbar interbody fusion (TLIF) is preferable in treating spondylolisthesis [13, 14] for its powerful ability to reduce anterolisthesis, restore disc height, and improve clinical outcomes [15, 16]. In clinical practice, both double-level TLIF and selective single-level TLIF are employed for contiguous double-level spondylolytic spondylolisthesis.
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