Degenerative spondylolisthesis – Functional outcome after transforaminal lumbar interbody fusion (TLIF) using single cage and without posterolateral fusion (PLF)

Abstract

Introduction

Results of surgical treatment of symptomatic degenerative spondylolisthesis (DS) with or without spinal canal stenosis is better than that of the non-operative treatment. Indications for surgical treatment includes: failed adequate trials of non-operative treatment at least for 3 to 6 months, progressive neurological deficits, bowel / bladder involvement. Different surgical options of neural decompression with or without instrumentation have been described in literatures. We present our result of Transforaminal Lumbar Interbody Fusion (TLIF) using single cage and without posterolateral fusion.

Material and methods

Over a period of 5 years between January 2013 and November 2018, files of 32 patients having Degenerative Spondylolisthesis treated surgically by TLIF procedure have been reviewed retrospectively.

All patients’ neurological status, preoperative visual analogue score and modified Oswestry Disability scores were recorded. All patients were subjected to standing antero-posterior and flexion / extension lateral views of lumbo-sacral spine. Percentage of the slip was calculated. They were subjected to Magnetic Resonance Imaging (MRI) to evaluate for amount of neural tissue compromise and status of the adjacent disc. Post-operatively all patients were followed up at 6 weeks, 3 months, 6 months, 1 year and subsequently every year. Post-operative improvement in VAS and ODI were recorded. Post-operative changes in the follow up x-rays were noted.

Results

There were 18 females and 14 males having average age of 55.19 + 10.14 years. The mean follow up period was 27. 47 + 17.62 months. Preoperative VAS score improved from 8.12 + 1.91 to 1.59 +1.41 and modified ODI reduced to 20 from 68.06 + 7.87 at last follow up. All patients demonstrated significant improvement in walking distance, which was only 40.78 + 36.41 meters before surgery.

Conclusions

TLIF is one of the viable options for surgical treatment of symptomatic Degenerative Spondylolisthesis with or without spinal canal stenosis. Use of single cage and interbody bone graft obtained from resection of the facet joint and without posterolateral fusion can produce comparable good to excellent results. It avoids morbidity associated with harvesting bone graft from the iliac crest.