Transforaminal L U Mbar Interbody Fusion in Low Grade Combined Lytic and Degenerative Spondylolidthesis : Functional Outcome of 21 Cases

Abstract

BACKGROUND: Spondylolisthesis is a heterogenous disorder characterised by subluxation of a vertebral body in sagittal plane occuring frequently at l4-5 and l5-S1commonest being isthmic and degenerative variety. While majority are asymptomatic, a subset do produce pain with neurology. Complete decompression of roots is essential, as is the need for solid stabilization. Several fusion techniques were reported in literature like PLF, TLIF, PLF, ALIF On theoretical grounds, TLIF has been suggested to be safe and result in an improved outcome compared to other techniques. Data to support this view, are lacking. METHODS: A total of 21 patients (age range, 27-62 years) with adult isthmic and degenerative spondylolisthesis were operated. There were 8 males and 13 females with mean age of 46.8 pre-op and 2-year followup, pain (VAS) and functional disability were quantified by Oswestry Disability Index (ODI).Radiological union assessed with xrays by Brantigen and Steffee criteria. The global outcome was excellent in 90%.and 92% fusion. 2 patients presented motor deficit which did not recover. RESULTS: The follow-up was for 2 years. The mean VAS score for low back pain improved from 7.0 preoperatively to 2.1, as did the mean VAS score for leg pain from 6.7 to 1.4 and the mean ODI from 59.5% to 11.3%. CONCLUSION: TLIF does affect the 2-year outcome of surgical treatment of spondylolisthesis with decreased back pain and ODI's, with advantages of minimal thecal retraction, restored segmental lordosis and preserved posterior tension band.