Clinical, radiological and functional results of transforaminal lumbar interbody fusion in degenerative spondylolisthesis

Abstract

Purpose To evaluate the clinical, functional and radiographic outcomes of transforaminal lumbar interbody fusion (TLIF) in degenerative low-grade spondylolisthesis. Materials and Methods A prospective observational study of 120 consecutive patients (M: F = 24:96) with spondylolisthesis operated with TLIF. Clinical and functional outcome was assessed on Visual analogue Scale (VAS) and Oswestry Disability Index(ODI). The radiological outcome was assessed on sagittal alignment at a specific level, radiologic bony fusion/non-union, intervertebral disc heights and percentage of a slip in relation to the endplate. Clinical and radiological data were collected and analysed. Results The mean age was 50.97 years. The average follow-up was 14.5 months (12 to 18 months). Mean preoperative ODI was 38.73 and postoperatively 21.30. Analysing the radiological fusion with clinical scores, poorer radiological fusion grades correlated with higher VAS scores for pain. 70% of patients achieved >50% reduction in pain and 60% achieved > 30% reduction in ODI. Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and lumbar lordosis (LL) were significantly greater in spondylolisthesis. PI, PT, and SS did not change statistically from the baseline postoperatively but increased LL and Segmental LL ( P < 0.001). The results of our study showed a close relation between satisfactory clinical outcome (90%) and solid fusion (80%). There was however a significant number of patients with instrument failure that was found in association with fusion failure. There were no intra-operative complications. Conclusion TLIF is an effective option to achieve circumferential fusion without severe complications. An increased pelvic incidence may be an important factor predisposing to progression in developmental spondylolisthesis. TLIF increases global and segmental LL and provides a satisfactory outcome in symptomatic low-grade degenerative spondylolisthesis.

Phẫu Thuật Điều Trị Mất Vững Cột Sống Thắt Lưng Bằng Phương Pháp Hàn Xương Liên Thân Đốt Qua Lỗ Liên Hợp

“…Tất cả các bệnh nhân đều đau cột sống thắt lưng và đau kiểu rễ thần kinh, trong đó ghi nhận 19 trường hợp có biểu hiện đi cách hồi thần kinh. Kết quả này tương đồng với các tác giả trong và ngoài nước như Võ Văn Thành, Kakadiya D. G. [6], [2], [7]. Đây là triệu chứng gây ảnh hưởng đến sinh hoạt và đời sống, bắt buộc bệnh nhân phải đến viện khám và điều trị.…”

Fusion’s Location and Quality within the Fixated Segment Following Transforaminal Interbody Fusion (TLIF)

“…During the surgery, indirect foraminal decompression of the neural elements is achieved, as the intervertebral disc is replaced with an intervertebral implant and bone graft, restoring proper intervertebral space and height, with subsequent posterolateral pedicle fixation for immediate construct stabilization [14,15]. The clinical results of successful fusion are depicted in alleviated post-operative pain scores and regained daily function [16]. As such, Kakadiya et al, reporting data from 120 patients following TLIF surgery, demonstrated approximately 70% pain reduction in the visual analogue scale (VAS) score and over 60% reduction in the Oswestry Disability index (ODI) [16].…”

“…The clinical results of successful fusion are depicted in alleviated post-operative pain scores and regained daily function [16]. As such, Kakadiya et al, reporting data from 120 patients following TLIF surgery, demonstrated approximately 70% pain reduction in the visual analogue scale (VAS) score and over 60% reduction in the Oswestry Disability index (ODI) [16].…”

“…TLIF is purported to be superior to the traditional posterolateral fusion (PLF) as it provides additional anterior column stability and 360 degrees fusion [14,[17][18][19]. However, there are mixed reports [16,19]. Levin et al, comparing PLF and TLIF procedures for the treatment of spondylolisthesis in a relatively large meta-analysis, demonstrated a significant improvement in terms of ODI favoring TLIF surgery, with pooled estimate effect size of −3.73 (95% confidence interval (CI), −7.09 to −0.38, p = 0.03).…”

Sagittal Alignment in the Degenerative Lumbar Spine

“…The historical target was "as much lordosis as possible." This continued until several authors, including Schwab et al and Lafage et al, proposed matching PI to LL within 10°, which has been shown to improve outcomes even in surgical procedures for degenerative pathology 35,[40][41][42][43][44][45][46][47][48][49][50][51] . It has been suggested to correct LL to PI 1 10°if the PI is low and to PI 2 10°if the PI is high 52 .…”