Transforaminal Lumbar Interbody Fusion in the Management of Single Level Low Grade Lumbar Degenerative Spondylolisthesis

Abstract

Background: Surgical procedures like transforaminal lumbar interbody fusion (TLIF) are becoming more common for treating degenerative spondylolisthesis (DS). This work aimed to evaluate the functional, radiographic outcomes of TLIF in the management of low-grade DS. Methods: thirty-six patients who had low grade degenerative spondylolisthesis with axial low back pain and/or leg pain refractory to medical treatment were involved in this retrospective-prospective cohort study with follow up period of two years. Assessment was done Oswestry Disability Index (ODI), neurogenic symptoms, and visual analogue scale scores (VAS) for back, leg pain. Anteroposterior, lateral and dynamic views radiology of the lumbosacral area to assess the degree of spondylolisthesis, lumbar lordosis together with measuring the spinopelvic parameters. Finally, computed tomography was done post operatively to evaluate the degree of fusion. Results: Comparing preoperative, 6 months postoperative and final outcome (2 years) VAS of back pain, VAS of leg pain and ODI among the operated patients (N=36), there was high significant change among them with follow up (P<0.001). The mean pelvic tilt (PT) decreased from 32.22(17-48) to 22.38 (12-39), with highly significant difference (p value <0.001). The sacral slope (SS) increased from 31.72(18-51) to 41.55(24-63), with highly significant difference (p value <0.001). The lumbar lordosis (LL) increased also from 52.50 (6-85) to 62.55 (36-101), with highly significant difference (p value <0.001). Conclusion: Low-grade degenerative spondylolisthesis can be effectively managed using TLIF, which has been shown to significantly improve the clinical and the radiological outcomes. It has the ability to preserve and restore healthy spinopelvic balance