Abhishek Komalsingh Jaroli1, Gajanand Dhaked2, Harish Narayansingh Rajpurohit3
BACKGROUND
Operative treatment and fusion for isthmic spondylolisthesis can be achieved by
various fusion techniques such as posterolateral fusion (PLF), anterior lumbar
interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal
lumbar interbody fusion (TLIF) and circumferential fusion. The purpose of this
study is to evaluate the clinical outcome and radiological correction achieved after
TLIF and assess the correlation between them if any.
METHODS
This is a retrospective cohort study analysing 30 cases of adult isthmic
spondylolisthesis who failed conservative treatment and were then treated with
transforaminal lumbar interbody fusion between 2011 and 2013. The clinical
follow-up was done with the modified Oswestry disability index (ODI) and visual
pain analogue score (VPAS). For the radiological follow-up radiographs were taken
and several radiographic parameters were noted and analysed.
RESULTS
The mean of the Oswestry disability index scores in all patients decreased from
67.73 to 13.1 at final follow up. Similarly, visual pain analogue score reduced from
mean 8.43 to 1.76 at final follow up. The average anterolisthesis was significantly
reduced from the preoperative 27.1 ± 14 % to 7.1 ± 5 % at final follow-up
radiographs (P < 0.001). Segmental lordosis increased from a mean of 11.5
degrees to 15.7 degrees. The difference in slip angle was significant from
preoperative -4.87 ± 4.8 degrees and - 7.23 ± 4.63 degrees on the initial
postoperative and - 7.2 ± 4.57 degrees at final follow-up radiographs (P = 0.14
and 0.13 respectively).
CONCLUSIONS
Thus, adult isthmic spondylolisthesis can be safely and effectively treated by TLIF
with significant clinical relief and decrease in disability. TLIF procedure in isthmic
spondylolisthesis is capable of reducing the sagittal translation and restoring disc
height. Also, sagittal alignment and lordosis can be restored to a large extent.
