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Transforaminal Lumbar Interbody Fusion With Local Bone Graft Alone for Single-Level Isthmic Spondylolisthesis

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Transforaminal Lumbar Interbody Fusion With Local Bone Graft Alone for Single-Level Isthmic Spondylolisthesis

Ahmed Sleem et al. Int J Spine Surg.

Abstract

Background: A retrospective study of patients treated by transforaminal lumbar interbody fusion (TLIF) with local bone graft alone for single-level isthmic spondylolisthesis (IS) between April 2009 and July 2014 in a single facility.

Methods: Demographic and operative data, complications, preoperative and postoperative clinical records, and radiographs were revised. The Visual Analogue Scale (VAS) and Denis Work Scale were used for clinical and functional assessment. Modified Lee et al. classification was used for assessment of union.

Results: Twenty-three patients with mean age of 45.04 ± 7.19 years had single-level TLIF with local bone graft alone for symptomatic IS with mean follow-up period of 28.39 ± 4.01 months and mean operative time of 170.09 ± 11.22 minutes. The VAS and Denis Work Scale improved from 8.48 ± 0.58 and 4.67 ± 0.47 preoperative to 2.91 ± 1.25 and 1.33 ± 0.58 at the latest follow up, respectively. Anterior vertebral translation improved from 27.22 ± 9.54% preoperatively to 8.38 ± 3.63% postoperatively and 10.39 ± 3.49 at the latest follow up. Disc space height was 9.67 ± 5.55% preoperatively, 21.60 ± 4.11% postoperative, and 16.24 ± 4.02% at the latest follow up. Lumbar lordosis improved from 29.39 ± 10.33° to 45.13 ± 6.84° postoperatively and 39.96 ± 7.52° at the latest follow up. Eighteen patients had definitive union, 4 patients with possible union, 1 patient with possible pseudoarthrosis.

Conclusions: Transforaminal lumbar interbody fusion with local bone graft alone is an appropriate option for single-level IS, yet we do not recommend it for higher grades of slippage with anterior vertebral translation more than 25%.

Keywords: IS; TLIF; isthmic spondylolisthesis; local bone graft; transforaminal lumbar interbody fusion.

Conflict of interest statement

Disclosures and COI: Institution review board approval was obtained. No conflict of interest.

Figures

Figure 1
Figure 1
(a) Radiographic measurement of anterior vertebral translation (AVT) and disc space height (DSH). Both are expressed as a percentage of the superior endplate diameter (SED) of the slipped vertebra. (b) Measurement of lumbar lordosis.
Figure 2
Figure 2
(a) Complete discectomy and end plate preparation. (b) Postoperative x-ray.

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