Surgical Outcomes Following Instrumented Fusion in Low-Grade Spondylolisthesis: A 26-Month Retrospective Analysis
-
Hindalahally Krishnegowda Karthik
,
Tushar V Ubale
,
Mahesh B Shinde
,
Mihir R Patel
,
Atharva Sharma
,
Kshitij Sarwey
,
Vinod Bhuktar
,
Sanket Jethliya
,
Naman Khurana
,
Tej Bopardikar
,
Vedita Bapat
,
Manni Dwivedi
Abstract
Background: Spondylolisthesis is characterized by the anterior or posterior displacement of a vertebra relative to the adjacent inferior vertebra. Patients with grade I-IV spondylolisthesis are initially treated by conservative measures, but surgical intervention becomes necessary for those with persistent symptoms. Surgical options range from pars repair in spondylosis to various fusion techniques, including instrumented reduction and fusion, or instrumented in situ fusion. The study aimed to evaluate the functional outcomes of surgical instrumentation in low-grade spondylolisthesis.
Methods: This retrospective study included 30 patients with low-grade spondylolisthesis who underwent surgical instrumentation. Pain and functional outcomes were evaluated using the Visual Analog Scale (VAS) and modified Oswestry Disability Index (ODI) at baseline and follow-up intervals.
Results: The baseline mean VAS score of 7.4 improved significantly at 6, 12, and 24 months (P < 0.01). The baseline mean ODI score of 66.8 also improved significantly at these intervals, with a final mean score of 12.51 at 24 months. Complications occurred in 3 patients, including neurological deficits and bone graft retropulsion.
Conclusion: Surgical instrumentation leads to significant improvements in pain and function in patients with low-grade spondylolisthesis, offering excellent outcomes for those unresponsive to conservative treatment.
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2. Kreiner DS, Baisden J, Mazanec DJ, Patel RD, Bess RS, Burton D, et al. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of adult isthmic spondylolisthesis. Spine J. 2016;16(12):1478-85. doi: 10.1016/j.spinee.2016.08.034. [PubMed: 27592807].
3. Panchal LC, Sarukte VL, Bhanushali RN. Study of functional outcome in low grade spondylolisthesis operated by pedicular screw instrumentation and fusion. Int J Med Res Rev. 2021;9(1):34-40. doi: 10.17511/ijmrr.2021.i01.05.
4. Boachie-Adjei O, Do T, Rawlins BA. Partial lumbosacral kyphosis reduction, decompression, and posterior lumbosacral transfixation in high-grade isthmic spondylolisthesis: clinical and radiographic results in six patients. Spine (Phila Pa 1976). 2002;27(6):E161-8. doi: 10.1097/00007632-200203150-00019. [PubMed: 11884921].
5. Boden SD, Riew KD, Yamaguchi K, Branch TP, Schellinger D, Wiesel SW. Orientation of the lumbar facet joints: association with degenerative disc disease. J Bone Joint Surg Am. 1996;78(3):403-11. doi: 10.2106/00004623-199603000-00012. [PubMed: 8613448].
6. Booth KC, Bridwell KH, Eisenberg BA, Baldus CR, Lenke LG. Minimum 5-year results of degenerative spondylolisthesis treated with decompression and instrumented posterior fusion. Spine (Phila Pa 1976). 1999;24(16):1721-7. doi: 10.1097/00007632-199908150-00014. [PubMed: 10472107].
7. Zhang S, Ye C, Lai Q, Yu X, Liu X, Nie T, et al. Double-level lumbar spondylolysis and spondylolisthesis: A retrospective study. J Orthop Surg Res. 2018;13(1):55. doi: 10.1186/s13018-018-0723-3. [PubMed: 29548343]. [PubMed Central: PMC5857125].
8. Hegde D, Mehra S, Babu S, Ballal A. A Study to Assess the Functional Outcome of Decompression and Posterior Lumbar Interbody Fusion of Low Grade Spondylolisthesis of Lumbar Vertebra. J Clin Diagn Res. 2017;11(3):Rc01-rc3. doi: 10.7860/jcdr/2017/25135.9531. [PubMed: 28511464]. [PubMed Central: PMC5427390].
9. Cole CD, McCall TD, Schmidt MH, Dailey AT. Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches. Curr Rev Musculoskelet Med. 2009;2(2):118-26. doi: 10.1007/s12178-009-9053-8. [PubMed: 19468868]. [PubMed Central: PMC2697340].
10. Harish S, Vijayaragavan R. Functional outcome of posterior decompression and stabilization with PLIF in degenerative lumbar instability. Int J Orthop Sci. 2024;10(3):33-6. doi: 10.22271/ortho.2024.v10.i3a.3576.
11. Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg. 2015;1(1):2-18. doi: 10.3978/j.issn.2414- 469x.2015.10.05. [PubMed: 27683674]. [PubMed Central: PMC5039869].
12. Patel DV, Yoo JS, Karmarkar SS, Lamoutte EH, Singh K. Interbody options in lumbar fusion. J Spine Surg. 2019;5 (Suppl 1):S19-s24. doi: 10.21037/jss.2019.04.04. [PubMed: 31380489]. [PubMed Central: PMC6626748].
13. Patel J, Kundnani V, Raut S, Meena M, Ruparel S. Perioperative Complications of Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF): 10 Years of Experience With MI-TLIF. Global Spine J. 2021;11(5):733-9. doi: 10.1177/2192568220941460. [PubMed: 32762388]. [PubMed Central: PMC8165925].
14. Narain AS, Hijji FY, Yom KH, Kudaravalli KT, Singh K. The Role of Minimally Invasive Techniques in the Treatment of Thoracolumbar Trauma. J Orthop Spine Trauma. 2016;2(3). doi: 10.5812/jost.10129.
15. Aithala JP, Kumar S, Aithal S, Kotian SM. Development of a Modified Disability Questionnaire for Evaluating Disability Caused by Backache in India and Other Developing Countries.Asian Spine J. 2018;12(6):1106-16. doi: 10.31616/asj.2018.12.6.1106.[PubMed: 30322245]. [PubMed Central: PMC6284133].
16. Vianin M. Psychometric properties and clinical usefulness of the Oswestry Disability Index. J Chiropr Med. 2008;7(4):161-3. doi: 10.1016/j.jcm.2008.07.001. [PubMed: 19646379]. [PubMed Central: PMC2697602].
17. Batra S, Garg B. Classification of Spondylolisthesis: Current Concepts. Indian Spine Journal. 2021;4(1):10. doi: 10.4103/ISJ.ISJ_61_20.
18. Koslosky E, Gendelberg D. Classification in Brief: The Meyerding Classification System of Spondylolisthesis. Clin Orthop Relat Res. 2020;478(5):1125-30. doi: 10.1097/corr.0000000000001153. [PubMed: 32282463]. [PubMed Central: PMC7170696].
19. Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, et al. Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults. J Am Acad Orthop Surg Glob Res Rev. 2018;2(3):e088. doi: 10.5435/jaaosglobal-d-17-00088. [PubMed: 30211382]. [PubMed Central: PMC6132313].
20. Kruse RA, White BA, Gudavalli S. Management of Lumbar Radiculopathy Associated With an Extruded L4-L5 Spondylolytic Spondylolisthesis Using Flexion-Distraction Manipulation: A Case Study. J Chiropr Med. 2019;18(4):311-6. doi: 10.1016/j.jcm.2019.02.001. [PubMed: 33408591]. [PubMed Central: PMC7774099].
21. Nimmagadda V, Seenappa H, Mittemari K, Paidipati R. Outcome of posterior lumbar interbody fusion in low-grade spondylolisthesis. Int J Res Orthop. 2021;7(5):991-5. doi: 10.18203/issn.2455-4510.IntJResOrthop20213380.
22. PST J, Somasundaram AK, Jeyaraman M. Does functional outcome mandate fusion in spondylolisthesis management? A retrospective analysis of 76 cases with one year follow-up. Indian J Orthop Surg. 2021;7(1):1-8. doi: 10.18231/j.ijos.2021.001.
25. Grob D, Humke T, Dvorak J. Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg Am. 1995;77(7):1036-41. doi: 10.2106/00004623-199507000-00009. [PubMed: 7608225].
24. Sharma A, Suthar T, Mathur M, Mittal V, Sharma S, Mehta G. The Clinical Outcome of Transforaminal Lumbar Interbody Fusion and Laminectomy for Single-Level Lumbar Canal Stenosis with Grade 1 and 2 Spondylolisthesis. J Orthop Spine Trauma. 2023;9(4):175-9. doi: 10.18502/jost.v9i4.13933.
2. Kreiner DS, Baisden J, Mazanec DJ, Patel RD, Bess RS, Burton D, et al. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of adult isthmic spondylolisthesis. Spine J. 2016;16(12):1478-85. doi: 10.1016/j.spinee.2016.08.034. [PubMed: 27592807].
3. Panchal LC, Sarukte VL, Bhanushali RN. Study of functional outcome in low grade spondylolisthesis operated by pedicular screw instrumentation and fusion. Int J Med Res Rev. 2021;9(1):34-40. doi: 10.17511/ijmrr.2021.i01.05.
4. Boachie-Adjei O, Do T, Rawlins BA. Partial lumbosacral kyphosis reduction, decompression, and posterior lumbosacral transfixation in high-grade isthmic spondylolisthesis: clinical and radiographic results in six patients. Spine (Phila Pa 1976). 2002;27(6):E161-8. doi: 10.1097/00007632-200203150-00019. [PubMed: 11884921].
5. Boden SD, Riew KD, Yamaguchi K, Branch TP, Schellinger D, Wiesel SW. Orientation of the lumbar facet joints: association with degenerative disc disease. J Bone Joint Surg Am. 1996;78(3):403-11. doi: 10.2106/00004623-199603000-00012. [PubMed: 8613448].
6. Booth KC, Bridwell KH, Eisenberg BA, Baldus CR, Lenke LG. Minimum 5-year results of degenerative spondylolisthesis treated with decompression and instrumented posterior fusion. Spine (Phila Pa 1976). 1999;24(16):1721-7. doi: 10.1097/00007632-199908150-00014. [PubMed: 10472107].
7. Zhang S, Ye C, Lai Q, Yu X, Liu X, Nie T, et al. Double-level lumbar spondylolysis and spondylolisthesis: A retrospective study. J Orthop Surg Res. 2018;13(1):55. doi: 10.1186/s13018-018-0723-3. [PubMed: 29548343]. [PubMed Central: PMC5857125].
8. Hegde D, Mehra S, Babu S, Ballal A. A Study to Assess the Functional Outcome of Decompression and Posterior Lumbar Interbody Fusion of Low Grade Spondylolisthesis of Lumbar Vertebra. J Clin Diagn Res. 2017;11(3):Rc01-rc3. doi: 10.7860/jcdr/2017/25135.9531. [PubMed: 28511464]. [PubMed Central: PMC5427390].
9. Cole CD, McCall TD, Schmidt MH, Dailey AT. Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches. Curr Rev Musculoskelet Med. 2009;2(2):118-26. doi: 10.1007/s12178-009-9053-8. [PubMed: 19468868]. [PubMed Central: PMC2697340].
10. Harish S, Vijayaragavan R. Functional outcome of posterior decompression and stabilization with PLIF in degenerative lumbar instability. Int J Orthop Sci. 2024;10(3):33-6. doi: 10.22271/ortho.2024.v10.i3a.3576.
11. Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg. 2015;1(1):2-18. doi: 10.3978/j.issn.2414- 469x.2015.10.05. [PubMed: 27683674]. [PubMed Central: PMC5039869].
12. Patel DV, Yoo JS, Karmarkar SS, Lamoutte EH, Singh K. Interbody options in lumbar fusion. J Spine Surg. 2019;5 (Suppl 1):S19-s24. doi: 10.21037/jss.2019.04.04. [PubMed: 31380489]. [PubMed Central: PMC6626748].
13. Patel J, Kundnani V, Raut S, Meena M, Ruparel S. Perioperative Complications of Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF): 10 Years of Experience With MI-TLIF. Global Spine J. 2021;11(5):733-9. doi: 10.1177/2192568220941460. [PubMed: 32762388]. [PubMed Central: PMC8165925].
14. Narain AS, Hijji FY, Yom KH, Kudaravalli KT, Singh K. The Role of Minimally Invasive Techniques in the Treatment of Thoracolumbar Trauma. J Orthop Spine Trauma. 2016;2(3). doi: 10.5812/jost.10129.
15. Aithala JP, Kumar S, Aithal S, Kotian SM. Development of a Modified Disability Questionnaire for Evaluating Disability Caused by Backache in India and Other Developing Countries.Asian Spine J. 2018;12(6):1106-16. doi: 10.31616/asj.2018.12.6.1106.[PubMed: 30322245]. [PubMed Central: PMC6284133].
16. Vianin M. Psychometric properties and clinical usefulness of the Oswestry Disability Index. J Chiropr Med. 2008;7(4):161-3. doi: 10.1016/j.jcm.2008.07.001. [PubMed: 19646379]. [PubMed Central: PMC2697602].
17. Batra S, Garg B. Classification of Spondylolisthesis: Current Concepts. Indian Spine Journal. 2021;4(1):10. doi: 10.4103/ISJ.ISJ_61_20.
18. Koslosky E, Gendelberg D. Classification in Brief: The Meyerding Classification System of Spondylolisthesis. Clin Orthop Relat Res. 2020;478(5):1125-30. doi: 10.1097/corr.0000000000001153. [PubMed: 32282463]. [PubMed Central: PMC7170696].
19. Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, et al. Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults. J Am Acad Orthop Surg Glob Res Rev. 2018;2(3):e088. doi: 10.5435/jaaosglobal-d-17-00088. [PubMed: 30211382]. [PubMed Central: PMC6132313].
20. Kruse RA, White BA, Gudavalli S. Management of Lumbar Radiculopathy Associated With an Extruded L4-L5 Spondylolytic Spondylolisthesis Using Flexion-Distraction Manipulation: A Case Study. J Chiropr Med. 2019;18(4):311-6. doi: 10.1016/j.jcm.2019.02.001. [PubMed: 33408591]. [PubMed Central: PMC7774099].
21. Nimmagadda V, Seenappa H, Mittemari K, Paidipati R. Outcome of posterior lumbar interbody fusion in low-grade spondylolisthesis. Int J Res Orthop. 2021;7(5):991-5. doi: 10.18203/issn.2455-4510.IntJResOrthop20213380.
22. PST J, Somasundaram AK, Jeyaraman M. Does functional outcome mandate fusion in spondylolisthesis management? A retrospective analysis of 76 cases with one year follow-up. Indian J Orthop Surg. 2021;7(1):1-8. doi: 10.18231/j.ijos.2021.001.
25. Grob D, Humke T, Dvorak J. Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg Am. 1995;77(7):1036-41. doi: 10.2106/00004623-199507000-00009. [PubMed: 7608225].
24. Sharma A, Suthar T, Mathur M, Mittal V, Sharma S, Mehta G. The Clinical Outcome of Transforaminal Lumbar Interbody Fusion and Laminectomy for Single-Level Lumbar Canal Stenosis with Grade 1 and 2 Spondylolisthesis. J Orthop Spine Trauma. 2023;9(4):175-9. doi: 10.18502/jost.v9i4.13933.
| Files | ||
| Issue | Vol 11 No 1 (2025) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v11i1.18009 | |
| Keywords | ||
| Spondylolisthesis Spinal Fusion Pain Measurement Postoperative Complications Low Back Pain | ||
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How to Cite
1.
Karthik H, Ubale T, Shinde M, Patel M, Sharma A, Sarwey K, Bhuktar V, Jethliya S, Khurana N, Bopardikar T, Bapat V, Dwivedi M. Surgical Outcomes Following Instrumented Fusion in Low-Grade Spondylolisthesis: A 26-Month Retrospective Analysis. J Orthop Spine Trauma. 2025;11(1):23-26.
