Background Data: Several controversies exist over the most appropriate approach for managing high grade spondylolisthesis; classic interbody fusions (PLIF) are associated with a considerable degree of complications.
Purpose: The aim of this work is to determine the safety and efficacy of unilateral TLIF in managing high grade isthmic spondylolisthesis.Study Design: Prospective, randomized, between 2000 and 2008. Patient Sample:44 patients with high grade isthmic spondylolisthesis (Meyerding grades III and IV).The mean age was 24y (range 17-38y). All patients had severe back and radicular symptoms that failed to conservative treatment. Eighteen were at L4/5 and 26 at
L5/S1. Outcome measures; total blood loss, operative time and hospital stay were recorded. Clinical outcome was assessed by the ODI and VAS. Fusion was assessed using plain radiographs.Methods: Limited decompression and indirect instrumented reduction was performed; 21 had additional unilateral TLIF (Group 1) and 23 had posterolateral
fusion using autograft bone (Group 2). Patients were followed-up for an average of 4.5y (range 2-7y).
Results: The average Oswestry Disability Index and Visual Analogue Scale showed better improvement in group 1 than group 2. In group 1 anterolisthesis improved from an average of 69% to 16% while in Group 2 it improved from an average of 64% to 19% at final follow up. Other parameters including improvement in disc space height, lumbar lordosis and angle of slip showed better improvement in group 1 than group 2. None in Group 1 had an implant failure and its overall fusion rate was 94%. In Group 2, the average operative time, blood loss and hospital stay were significantly less but two patients had implant failure requiring revision and the overall complications were 6/23 patients.
Conclusion: Direct instrumented reduction and TLIF is an efficient option to treat high grade isthmic spondylolisthesis. It provided immediate stability and superior clinical and radiological outcomes.(2012ESJ005)