Comparing the clinical and radiological outcomes of pedicular transvertebral screw fixation of the lumbosacral spine in spondylolisthesis versus unilateral transforaminal lumbar interbody fusion (TLIF) with posterior fixation using anterior cages

Abstract

Study design: This study retrospectively compares the clinical and radiologic outcomes of unilateral transforaminal lumbar interbody fusion (TLIF) with those of transvertebral screw fixation of the lumbosacral spine in high-grade spondylolisthesis.

Objective: To examine the outcome and perioperative complications of unilateral TLIF and compare those results with Transvertebral Screw Fixation in the treatment of high-grade spondylolisthesis.

Summary of background data: High-grade spondylolisthesis has been associated with a high complication and failure rate regardless of the method of treatment. We compare 2 techniques to improve success rates.

Methods: Forty patients were divided into 2 groups: group A, unilateral TLIF, and group B, transacral screws. The mean age was 33 years (range, 19-48 years), and the mean follow-up was 35 months (range, 24-48 months). The mean grade of spondylolisthesis measured by Meyerding grading was 3.6 (range, 3-5). A Scoliosis Research Society outcome score was obtained on all patients. Fusion was determined by both radiograph and computed tomography scan.

Results: Group A: 100% fusion. The slip angle improved from 38.6 degrees (range, 24-78 degrees ) before surgery to 23.8 degrees (range, 12-38 degrees ) after surgery. Group B: 95% of patients evidenced solid fusion by the 6-month follow-up. The slip angle, improved from 38.2 degrees (range, 22-78 degrees ) before surgery to 23 degrees (range, 9-36 degrees ) after surgery. There was no significant improvement in the percentage slip or the sacral inclination in any of the groups.

Complications: A: 7 unintended durotomies and 3 wound infections. B: 1 unintended durotomy, 1 pseudarthrosis, 2 wound infections, and 1 implant failure. There were no neurologic complications in any of the groups. The Scoliosis Research Society outcome instrument demonstrated good postoperative pain control, function, self-image, and satisfaction in both groups.

Conclusion: No significant differences in radiologic and clinical outcome were found, in either group. Both procedures appear to be safe and effective surgically and radiographically.