Preeth Sai, B Vijayanand, C Rishab, Robin A, Dhasarathy Sidharthan
Department of Orthopedics, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, Kattankulathur, IND.
Department of Orthopedic Surgery, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, Kattankulathur, IND.
Cureus. 2024 Aug 26;16(8):e67880. doi: 10.7759/cureus.67880. eCollection 2024 Aug.
Spondylolisthesis is a common spinal condition in which one vertebra slips over another, leading to pain and disability. Transforaminal lumbar interbody fusion (TLIF) has emerged as a surgical option for addressing spondylolisthesis; however, limited research exists, especially in the Indian context, evaluating its radiological and functional outcomes.
The study aimed to evaluate the radiological and functional outcomes of TLIF in spondylolisthesis using standardized scoring systems, to evaluate the sagittal balance of the spine radiologically in patients who have undergone TLIF for spondylolisthesis, and to evaluate the correlation between the functional and radiological outcomes after TLIF.
This prospective observational study included spondylolisthesis patients undergoing TLIF at SRM Medical College Hospital and Research Centre from August 2022 to August 2024. Criteria included Meyerding grade 1-4 spondylolisthesis, single-segment fusion, and willingness for 12-month follow-up.
Forty-five patients were included with age 36.6 ± 12.2 years, with 73.3% being female. L4-L5 is the most common level affected in 21 patients (46.7%). Significant improvements were observed in pelvic tilt 19.07 ± 2.05, sacral slope 30.6 ± 4.4, segmental lordosis 18.4 ± 1.4, lumbar lordosis 57.1 ± 1.8, sagittal vertical axis (SVA) 2.5 ± 0.3, Visual Analog Scale for pain 0.4 ± 0.5, and Oswestry Disability Index (ODI) scores 5.23 ± 2.6 postoperatively (p < 0.05). At one-year follow-up, 84.4% of patients had good-to-excellent outcomes, and 44.4% had definitive fusion according to modified Lee criteria. However, there was no correlation between ODI score and grade of listhesis, pelvic incidence (PI), or SVA of the spine (p > 0.05).
This study provides valuable insights into the effectiveness of TLIF surgery in addressing spondylolisthesis, both in terms of radiological and functional outcomes. However, there was no correlation between improvement in functional and radiological parameters (PI vs. ODI, SVA vs. ODI). TLIF appears to offer significant improvements in patient well-being and quality of life. These findings contribute to understanding TLIF's suitability as a treatment for spondylolisthesis and can inform clinical practice, ultimately benefiting patients suffering from this condition.
腰椎滑脱是一种常见的脊柱疾病，其中一个椎体在另一个椎体上滑移，导致疼痛和功能障碍。经椎间孔腰椎椎体间融合术（TLIF）已成为治疗腰椎滑脱的一种手术选择；然而，相关研究有限，尤其是在印度背景下，对其放射学和功能结果的评估较少。
本研究旨在使用标准化评分系统评估TLIF治疗腰椎滑脱的放射学和功能结果，通过放射学评估接受TLIF治疗腰椎滑脱患者的脊柱矢状面平衡，并评估TLIF后功能和放射学结果之间的相关性。
这项前瞻性观察性研究纳入了2022年8月至2024年8月在SRM医学院医院和研究中心接受TLIF的腰椎滑脱患者。纳入标准包括迈耶丁1-4级腰椎滑脱、单节段融合以及愿意接受12个月的随访。
纳入45例患者，年龄36.6±12.2岁，73.3%为女性。L4-L5是最常受累节段，有21例患者（46.7%）。术后骨盆倾斜度19.07±2.05、骶骨倾斜度30.6±4.4、节段性前凸18.4±1.4、腰椎前凸57.1±1.8、矢状垂直轴（SVA）2.5±0.3、视觉模拟疼痛评分0.4±0.5和Oswestry功能障碍指数（ODI）评分5.23±2.6均有显著改善（p<0.05）。在1年随访时，根据改良Lee标准，84.4%的患者获得了良好至优秀的结果，44.4%的患者实现了确定性融合。然而，ODI评分与滑脱分级、骨盆入射角（PI）或脊柱SVA之间无相关性（p>0.05）。
本研究为TLIF手术治疗腰椎滑脱在放射学和功能结果方面的有效性提供了有价值的见解。然而，功能和放射学参数的改善之间没有相关性（PI与ODI、SVA与ODI）。TLIF似乎能显著改善患者的健康状况和生活质量。这些发现有助于理解TLIF作为腰椎滑脱治疗方法的适用性，并可为临床实践提供参考，最终使患有这种疾病的患者受益。
