Modified transforaminal lumbar interbody fusion with distraction reduction for the treatment of degenerative lumbar spondylolisthesis

ZHENG Chaojun; JIANG Jianyuan; WANG Hongli; LV Feizhou; MA Xiaosheng; XIA Xinlei; WANG Lixun; SHAO Minghao

doi:10.3969/j.issn.1674-666X.2013.04.004

Abstract：Objective To study the feasibility and clinical effect of modified transforaminal lumbar interbody fusion (TLIF) with distraction reduction for the treatment of degenerative lumbar spondylolisthesis. Methods Clinical data of 84 patients with single-level degenerative lumbar spondylolisthesis treated by modified TLIF and distraction reduction in Huashan Hospital affiliated to Fudan University from March 2007 to October 2011 were collected and analyzed retrospectively, preoperative and postoperative visual analogue scale (VAS) pain score, Japanese Orthopedics Association (JOA) score, intervertebral space height, the degrees of lumbar lordosis (Cobb angle) and spondylolisthesis were measured, the radiographic fusion condition was evaluated at 3 months and 1 year after the operation by X-ray or CT scanning. Results The average operating time was (170 ± 38) min, and the intraoperative estimate blood loss was (274 ± 82) mL. All patients were followed up from 3 months after the surgery, and 79 patients were followed up to 1 year (79/84, 94%). At three months and one year follow-up, the postoperative intervertebral space height recovered significantly (P <0.05), however, there was no significant statistical difference between pre- and post-operative Cobb angle (P >0.05). At three months follow-up, 34 patients got total reduction (40%), along with partial reduction in the other 50 patients; at one year follow-up, the improvement rate of the degree of spondylolisthesis was 84%. Postoperative VAS pain scores and JOA scores improved significantly (P <0.05) compared with preoperative ones. According to JOA evaluation criteria, there were excellent in 59 cases, good in 20 cases, fair in 5 cases, with the average improvement rate of 87%. Three months after the operation, 57 of 84 patients (67.8%) had the radiographic fusion, and at one year follow-up, all 79 patients (100%) got the radiographic fusion. At one year follow-up, there was no complications such as nerve injuries, dural tear, pedicle screw loosening or breakage, interbody fusion cage displacement and subsidence. Conclusion Modified TLIF with distraction reduction is a relatively safe and easy-acceptable method, which always has a good clinical result for the patients with single-level degenerative lumbar spondylolisthesis.