Introduction: Various surgical approaches have been described previously for spondylolisthesis including in situ fusions, partial reduction as well as fusion of healthy adjacent segments. To our knowledge, there have been no reports describing complete reduction and monosegmental transforaminal lumbar interbody fusion for spondylolisthesis especially using minimally invasive technique.
Methods: A cohort study consisting of a total of 20 consecutive patients over a period of 5 years. Patients with varying grades of lumbar spondylolisthesis (Meyerding II – IV: 14 grade II, 5 grade III & 1 grade IV) were treated with operative reduction via minimally invasive transforaminal lumbar interbody fusion. The clinical outcomes were measured using the Visual Analog Pain Scale and the Revised Oswestry Disability Index (for low back pain/dysfunction) scoring. Radiographic paramenters of Whole lumbar lordosis, Slip angle, Grade and Sacral slope were assessed to measure the radiological outcomes. These were prospectively reviewed for each patient for a minimum of 2 years.
Results: At most recent follow-up, most patients were pain free. There were few patients who had moderate pain (which corresponded to higher grade of listhesis), but all showed an improvement in pain scores (p < 0.05).
All radiographic parameters improved and good fusion achieved with implants in-situ at 2 year follow up. 100% complete reduction of all grades of spondylolisthesis was achieved. The overall sagittal profile improved dramatically. No major perioperative complications encountered.
Conclusions: Listhesis reduction with minimally invasive monosegmental transforaminal lumbar interbody fusion is an effective technique for the treatment of various grades of spondylolisthesis. Complete reduction of listhesis as well as excellent correction of overall sagittal profile can be achieved, along with avoidance of fusing the healthy adjacent segment. Further, the use of minimally invasive technique may aid in faster recovery, early ambulation with minimal blood loss.
Patient Care: By reducing overall morbidity and better clinical outcomes
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of spodylolisthesis reduction, 2) Discuss, in small groups,role of fusion in listhesis, 3) Identify an effective treatment in the form of minimally invasive technique for listhesis correction