Clinical and Radiological Outcomes in Patients of Isthmic Spondylolisthesis Treated with Transforaminal Lumbar Interbody Fusion - A Retrospective Cohort Study, New Delhi

Abstract

BACKGROUND Operative treatment and fusion for isthmic spondylolisthesis can be achieved by various fusion techniques such as posterolateral fusion (PLF), anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) and circumferential fusion. The purpose of this study is to evaluate the clinical outcome and radiological correction achieved after TLIF and assess the correlation between them if any. METHODS This is a retrospective cohort study analysing 30 cases of adult isthmic spondylolisthesis who failed conservative treatment and were then treated with transforaminal lumbar interbody fusion between 2011 and 2013. The clinical follow-up was done with the modified Oswestry disability index (ODI) and visual pain analogue score (VPAS). For the radiological follow-up radiographs were taken and several radiographic parameters were noted and analysed. RESULTS The mean of the Oswestry disability index scores in all patients decreased from 67.73 to 13.1 at final follow up. Similarly, visual pain analogue score reduced from mean 8.43 to 1.76 at final follow up. The average anterolisthesis was significantly reduced from the preoperative 27.1 ± 14 % to 7.1 ± 5 % at final follow-up radiographs (P < 0.001). Segmental lordosis increased from a mean of 11.5 degrees to 15.7 degrees. The difference in slip angle was significant from preoperative -4.87 ± 4.8 degrees and - 7.23 ± 4.63 degrees on the initial postoperative and - 7.2 ± 4.57 degrees at final follow-up radiographs (P = 0.14 and 0.13 respectively). CONCLUSIONS Thus, adult isthmic spondylolisthesis can be safely and effectively treated by TLIF with significant clinical relief and decrease in disability. TLIF procedure in isthmic spondylolisthesis is capable of reducing the sagittal translation and restoring disc height. Also, sagittal alignment and lordosis can be restored to a large extent. KEYWORDS Spondylolisthesis, Pelvic Incidence, Sagittal Balance, TLIF