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Subject Area

Degenerative

Article Type

Original Study

Abstract

Background Data: Several controversies exist over the most appropriate approach for managing high grade spondylolisthesis; classic interbody fusions (PLIF) are associated with a considerable degree of complications.Purpose: The aim of this work is to determine the safety and efficacy of unilateral TLIF in managing high grade isthmic spondylolisthesis.Study Design: Prospective, randomized, between 2000 and 2008. Patient Sample:44 patients with high grade isthmic spondylolisthesis (Meyerding grades III and IV).The mean age was 24y (range 17-38y). All patients had severe back and radicular symptoms that failed to conservative treatment. Eighteen were at L4/5 and 26 atL5/S1. Outcome measures; total blood loss, operative time and hospital stay were recorded. Clinical outcome was assessed by the ODI and VAS. Fusion was assessed using plain radiographs.Methods: Limited decompression and indirect instrumented reduction was performed; 21 had additional unilateral TLIF (Group 1) and 23 had posterolateralfusion using autograft bone (Group 2). Patients were followed-up for an average of 4.5y (range 2-7y).Results: The average Oswestry Disability Index and Visual Analogue Scale showed better improvement in group 1 than group 2. In group 1 anterolisthesis improved from an average of 69% to 16% while in Group 2 it improved from an average of 64% to 19% at final follow up. Other parameters including improvement in disc space height, lumbar lordosis and angle of slip showed better improvement in group 1 than group 2. None in Group 1 had an implant failure and its overall fusion rate was 94%. In Group 2, the average operative time, blood loss and hospital stay were significantly less but two patients had implant failure requiring revision and the overall complications were 6/23 patients.Conclusion: Direct instrumented reduction and TLIF is an efficient option to treat high grade isthmic spondylolisthesis. It provided immediate stability and superior clinical and radiological outcomes.(2012ESJ005)

Keywords

high grade, Spondylolisthesis, Transforaminal, interbody fusion

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