Clinical, radiological and functional results of transforaminal lumbar interbody fusion in degenerative spondylolisthesis

Dr Ghanshyam Kakadiya; Dr Kushal Gohil; Dr Yogesh Soni; Dr Akash Shakya

doi:10.1016/j.xnsj.2020.100011

Clinical, radiological and functional results of transforaminal lumbar interbody fusion in degenerative spondylolisthesis

N Am Spine Soc J. 2020 Jun 13:2:100011. doi: 10.1016/j.xnsj.2020.100011. eCollection 2020 Aug.

Authors

Dr Ghanshyam Kakadiya¹, Dr Kushal Gohil², Dr Yogesh Soni³, Dr Akash Shakya⁴

Affiliations

¹ Assistant Professor (MS Orthopaedics), Department of Orthopaedics, TNMC & BYL Nair Hospital, Mumbai-400008, India.
² Spine Fellow (MS Orthopaedics, DNB), Park Clinic, Kolkata, India.
³ Senior Resident Doctor, (MS Orthopaedics, DNB) Department of Orthopaedics, TNMC & BYL Nair Hospital, Mumbai-400008, India.
⁴ Senior Resident Doctor (MS Orthopaedics, DNB), Department of Orthopaedics, ESI Hospital, Mumbai, India.

Abstract

Purpose: To evaluate the clinical, functional and radiographic outcomes of transforaminal lumbar interbody fusion (TLIF) in degenerative low-grade spondylolisthesis.

Materials and methods: A prospective observational study of 120 consecutive patients (M:F = 24:96) with spondylolisthesis operated with TLIF. Clinical and functional outcome was assessed on Visual analogue Scale (VAS) and Oswestry Disability Index(ODI). The radiological outcome was assessed on sagittal alignment at a specific level, radiologic bony fusion/non-union, intervertebral disc heights and percentage of a slip in relation to the endplate. Clinical and radiological data were collected and analysed.

Results: The mean age was 50.97 years. The average follow-up was 14.5 months (12 to 18 months). Mean preoperative ODI was 38.73 and postoperatively 21.30. Analysing the radiological fusion with clinical scores, poorer radiological fusion grades correlated with higher VAS scores for pain. 70% of patients achieved >50% reduction in pain and 60% achieved > 30% reduction in ODI. Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and lumbar lordosis (LL) were significantly greater in spondylolisthesis. PI, PT, and SS did not change statistically from the baseline postoperatively but increased LL and Segmental LL (P < 0.001). The results of our study showed a close relation between satisfactory clinical outcome (90%) and solid fusion (80%). There was however a significant number of patients with instrument failure that was found in association with fusion failure. There were no intra-operative complications.

Conclusion: TLIF is an effective option to achieve circumferential fusion without severe complications. An increased pelvic incidence may be an important factor predisposing to progression in developmental spondylolisthesis. TLIF increases global and segmental LL and provides a satisfactory outcome in symptomatic low-grade degenerative spondylolisthesis.

Keywords: Pelvic incidence; Spinopelvic parameters; Spondylolisthesis; TLIF.