Main Article Content
Abstract
BACKGROUND
Lumbar interbody fusion has long been considered the "gold standard" technique for surgical treatment of adult spondylolisthesis. Superior results have subsequently been reported with interbody fusion with cages and posterior instrumentation. The objectives of the study were to determine the functional outcome after one year following surgery and evaluate the fusion rate.
METHODS
In this prospective, non-randomised study, 26 patients (average age 37.1 yrs) with isthmic spondylolisthesis (IS), who suffered for an average of 12.08 months and 14 patients with degenerative spondylolisthesis (DS) (average age 58.6 yrs), who suffered for 13.2 months on average were collected in out-patient department basis. They underwent an interbody fusion with cages with posterior instrumentation (TLIF or PLIF). Clinical outcome was measured using VAS and Oswestry Disability Index. Foraminal dimensions and disc heights were measured in standard digital radiographs. Radiographic fusion was confirmed with CT scans at 1 year.
RESULTS
In the IS group, a mean spondylolisthesis slip of 33.3 % was reduced to 6.7 % at 1 year. Vertical foraminal distance(C) was improved from 11.2 mm to 12.0 mm. The fusion rate was 78.2 % with TLIF and 66.7 % with PLIF. In the DS group, a mean spondylolisthesis slip of 32.7 % was reduced to 7.4 % at 1 year. C distance was improved from 11.8 mm to 13.2 mm. The fusion rate was 66.7 % with TLIF and 100 % with PLIF. The mean ODI scores at baseline and 1 year, were improved from 48 to 9.8 and from 49.5 to 18.4 in the IS and DS groups respectively. VAS score was improved from 6.4 to 0.8 and from 6.6 to 2.5 in IS and DS groups respectively.
CONCLUSIONS
Interbody fusion for low-grade spondylolisthesis requiring reduction results in excellent to good functional outcomes in 90 % of patients with a good fusion rate. TLIF procedure of spinal fusion requires less time, causes less bleeding, and has less chance of damage to the neural structures than PLIF.
Keywords
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References
- Wiltse LL, Newman PH, Macnab I. Classification of spondylolysis and spondylolisthesis. Clin Orthop Relat Res 1976;117:23-9.
- Marchetti PG, Bartolozzi P. Classification of spondylolisthesis as a guideline for treatment. In: Bridwell KH, DeWald RL, eds. The textbook of spinal surgery. 2nd edn. Philadelphia, PA: Lippincott-Raven 1997:1211-54.
- Meyerding HW. Spondylolisthesis. Surg Gynecol Obstet 1932;54:371-7.
- DeWald RL, Faut MM, Taddonio RF, et al. Severe lumbosacral spondylolisthesis in adolescents and children. Reduction and staged circumferential fusion. J Bone Joint Surg Am 1981;63(4):619-26.
- Beutler WJ, Friedrickson BE, Murtland A, et al. The natural history of spondylolysis and spondylolisthesis: 45 years follow-up evaluation. Spine 2003;28(10):1027-35.
- Audat ZM, Darwish FT, Al Barbarawi MM, et al. Surgical management of low grade isthmic spondylolisthesis; a randomized controlled study of the surgical fixation with and without reduction. Scoliosis 2011;6(1):14.
- Jacobs WC, Vreeling A, De Kleuver M. Fusion for low-grade adult isthmic spondylolisthesis: a systematic review of the literature. Eur Spine J 2006;15(4):391-402.
- Steffee AD, Sitkowski DJ. Posterior lumbar interbody fusion and plates. Clin Orthop Relat Res 1988;227:99-102.
- Harms J. Screw-threaded rod system in spinal fusion surgery. Spine 1992;6:541-75.
- Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression and intertranseverse progress arthrodesis. J Bone Joint Surg Am 1991;73(6):802-8.
- Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg 1953;10(2):154-68.
- Lerat JL, Rubini J, Vincent P, et al. Results of posterior lumbar intersomatic fusion in the treatment of isthmic spondylolisthesis. Apropos of 27 cases followed over more than 10 years. Rev Chir Orthopreparatrice Appar Mot 1996;82(6):475-89.
- Brantigan JW, Steffee AD, Lewis M, et al. Lumbar interbody fusion using the Brantigan I/F cage for posterior lumbar interbody fusion and the variable pedicle screw placement system: two-year results from a Food and Drug Administration investigational device exemption clinical trial. Spine (Phila Pa 1976) 2000;25(11):1437-46.
- Harms JG, Jeszenszky D. The unilateral, transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol 1998;6:88-99.
- Humphreys SC, Hodges SD, Patwardhan AG, et al. Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine (Phila Pa 1976) 2001;26(5):567-71.
- Ozgur BM, Aryan HE, Pimenta L, Taylor WR: Extreme Lateral Interbody Fusion (XLIF): A novel surgical technique for anterior lumbar interbody fusion. Spine J.2006, 6:435–43
- Hasegewa K, Kitahara K, Hara T, et al. Biomechanical evaluation of segmental instability in degenerative lumbar spondylolisthesis. Eur Spine J 2009;18(4):465-70.
- Iguchi T, Nishida K, Ozaki T, et al. Grade three disc degeneration is a critical stage for anterior spondylolisthesis in lumbar spine. Eur Spine J 2012;21(11):2134-9.
- Hagenmaier HSF, Delawi D, Verschoor N, et al. No correlation between slip reduction in low-grade spondylolisthesis or change in neuroforaminal morphology and clinical outcome. BMC Musculoskeletal Disorders 2013;14(1):245.
- Steven R, Garin FJE, Bell GR. Rothman-Simeone and Herkowitz’s the spine. 7th edn. Philadelphia: Elsevier 2018.
- Yan DL, Pei FX, Li J, et al. Comparative study of PILF and TLIF treatment in adult degenerative spondylolisthesis. Eur Spine J 2008;17(10):1311-6.
- Fujibayashi S, Hynes RA, Otsuki B, et al. Effect of indirect neural decompression through oblique lateral interbody fusion for degenerative lumbar disease. Spine (Phila Pa 1976) 2015;40(3):E175-82.
- Alvi MA, Alkhataybeh R, Wahood W, et al. The impact of adding posterior instrumentation to transpsoas lateral fusion: a systematic review and meta-analysis. J Neurosurg Spine 2018;30(2):211-21.
- Forsth P, Olafsson G, Carlsson T, et al. A randomized controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med 2016;374(15):1413-23.
- Sigmundsson FG, Jonsson B, Stromqvist B. Outcome of decompression with and without fusion in spinal stenosis with degenerative spondylolisthesis in relation to preoperative pain pattern: a register study of 1,624 patients. Spine J 2015;15(4):638-46.
- Sato J, Ohtori S, Orita S, et al. Radiographic evaluation of indirect decompression of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lateral interbody fusion for degenerated lumbar spondylolisthesis. Eur Spine J 2017;26(3):671-8.
- Zagra A, Giudici F, Minoia L et al. Long-term results of pediculo-body fixation and posterolateral fusion for lumbar spondylolisthesis. Eur Spine J 2009;18 Suppl 1:151-5.
- Fan G, Zhang H, Guan X, et al. Patient-reported and radiographic outcomes of minimally invasive transforaminal lumbar interbody fusion for degenerative spondylolisthesis with or without reduction: a comparative study. J Clin Neurosci 2016;33:111-8.
- Melikian R, Yoon ST, Kim JY, et al. Sagittal plane correction using the lateral transpsoas approach: a biomechanical study on the effect of cage angle and surgical technique on segmental lordosis. Spine (Phila Pa 1976) 2016;41(17):E1016-21.
- Otsuki B, Fujibayashi S, Takemoto M, et al. Analysis of the factors affecting lumbar segmental lordosis after lateral lumbar Interbody fusion. Spine (Phila Pa 1976) 2020;45(14):E839-46.
- Benli IT, Cicek H, Kaya A. Comparison of sagittal plane realignment and reduction with posterior instrumentation in developmental low or high dysplastic spondylolisthesis. Kobe J Med Sci 2006;52(6):151-69.
References
Wiltse LL, Newman PH, Macnab I. Classification of spondylolysis and spondylolisthesis. Clin Orthop Relat Res 1976;117:23-9.
Marchetti PG, Bartolozzi P. Classification of spondylolisthesis as a guideline for treatment. In: Bridwell KH, DeWald RL, eds. The textbook of spinal surgery. 2nd edn. Philadelphia, PA: Lippincott-Raven 1997:1211-54.
Meyerding HW. Spondylolisthesis. Surg Gynecol Obstet 1932;54:371-7.
DeWald RL, Faut MM, Taddonio RF, et al. Severe lumbosacral spondylolisthesis in adolescents and children. Reduction and staged circumferential fusion. J Bone Joint Surg Am 1981;63(4):619-26.
Beutler WJ, Friedrickson BE, Murtland A, et al. The natural history of spondylolysis and spondylolisthesis: 45 years follow-up evaluation. Spine 2003;28(10):1027-35.
Audat ZM, Darwish FT, Al Barbarawi MM, et al. Surgical management of low grade isthmic spondylolisthesis; a randomized controlled study of the surgical fixation with and without reduction. Scoliosis 2011;6(1):14.
Jacobs WC, Vreeling A, De Kleuver M. Fusion for low-grade adult isthmic spondylolisthesis: a systematic review of the literature. Eur Spine J 2006;15(4):391-402.
Steffee AD, Sitkowski DJ. Posterior lumbar interbody fusion and plates. Clin Orthop Relat Res 1988;227:99-102.
Harms J. Screw-threaded rod system in spinal fusion surgery. Spine 1992;6:541-75.
Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression and intertranseverse progress arthrodesis. J Bone Joint Surg Am 1991;73(6):802-8.
Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg 1953;10(2):154-68.
Lerat JL, Rubini J, Vincent P, et al. Results of posterior lumbar intersomatic fusion in the treatment of isthmic spondylolisthesis. Apropos of 27 cases followed over more than 10 years. Rev Chir Orthopreparatrice Appar Mot 1996;82(6):475-89.
Brantigan JW, Steffee AD, Lewis M, et al. Lumbar interbody fusion using the Brantigan I/F cage for posterior lumbar interbody fusion and the variable pedicle screw placement system: two-year results from a Food and Drug Administration investigational device exemption clinical trial. Spine (Phila Pa 1976) 2000;25(11):1437-46.
Harms JG, Jeszenszky D. The unilateral, transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol 1998;6:88-99.
Humphreys SC, Hodges SD, Patwardhan AG, et al. Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine (Phila Pa 1976) 2001;26(5):567-71.
Ozgur BM, Aryan HE, Pimenta L, Taylor WR: Extreme Lateral Interbody Fusion (XLIF): A novel surgical technique for anterior lumbar interbody fusion. Spine J.2006, 6:435–43
Hasegewa K, Kitahara K, Hara T, et al. Biomechanical evaluation of segmental instability in degenerative lumbar spondylolisthesis. Eur Spine J 2009;18(4):465-70.
Iguchi T, Nishida K, Ozaki T, et al. Grade three disc degeneration is a critical stage for anterior spondylolisthesis in lumbar spine. Eur Spine J 2012;21(11):2134-9.
Hagenmaier HSF, Delawi D, Verschoor N, et al. No correlation between slip reduction in low-grade spondylolisthesis or change in neuroforaminal morphology and clinical outcome. BMC Musculoskeletal Disorders 2013;14(1):245.
Steven R, Garin FJE, Bell GR. Rothman-Simeone and Herkowitz’s the spine. 7th edn. Philadelphia: Elsevier 2018.
Yan DL, Pei FX, Li J, et al. Comparative study of PILF and TLIF treatment in adult degenerative spondylolisthesis. Eur Spine J 2008;17(10):1311-6.
Fujibayashi S, Hynes RA, Otsuki B, et al. Effect of indirect neural decompression through oblique lateral interbody fusion for degenerative lumbar disease. Spine (Phila Pa 1976) 2015;40(3):E175-82.
Alvi MA, Alkhataybeh R, Wahood W, et al. The impact of adding posterior instrumentation to transpsoas lateral fusion: a systematic review and meta-analysis. J Neurosurg Spine 2018;30(2):211-21.
Forsth P, Olafsson G, Carlsson T, et al. A randomized controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med 2016;374(15):1413-23.
Sigmundsson FG, Jonsson B, Stromqvist B. Outcome of decompression with and without fusion in spinal stenosis with degenerative spondylolisthesis in relation to preoperative pain pattern: a register study of 1,624 patients. Spine J 2015;15(4):638-46.
Sato J, Ohtori S, Orita S, et al. Radiographic evaluation of indirect decompression of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lateral interbody fusion for degenerated lumbar spondylolisthesis. Eur Spine J 2017;26(3):671-8.
Zagra A, Giudici F, Minoia L et al. Long-term results of pediculo-body fixation and posterolateral fusion for lumbar spondylolisthesis. Eur Spine J 2009;18 Suppl 1:151-5.
Fan G, Zhang H, Guan X, et al. Patient-reported and radiographic outcomes of minimally invasive transforaminal lumbar interbody fusion for degenerative spondylolisthesis with or without reduction: a comparative study. J Clin Neurosci 2016;33:111-8.
Melikian R, Yoon ST, Kim JY, et al. Sagittal plane correction using the lateral transpsoas approach: a biomechanical study on the effect of cage angle and surgical technique on segmental lordosis. Spine (Phila Pa 1976) 2016;41(17):E1016-21.
Otsuki B, Fujibayashi S, Takemoto M, et al. Analysis of the factors affecting lumbar segmental lordosis after lateral lumbar Interbody fusion. Spine (Phila Pa 1976) 2020;45(14):E839-46.
Benli IT, Cicek H, Kaya A. Comparison of sagittal plane realignment and reduction with posterior instrumentation in developmental low or high dysplastic spondylolisthesis. Kobe J Med Sci 2006;52(6):151-69.