Prospective Assessment of Transforaminal Lumbar Interbody Fusion (TLIF) in Spondylolisthesis: A Radiological and Functional Outcome Study in an Indian Population.

INTRODUCTION

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.

OBJECTIVE

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.