Transforaminal Lumbar Interbody Fusion for the Treatment of Spondylolisthesis and Degenerative Segmental Instability; Surgical and Radiological Outcome

Background: Transforaminal lumbar interbody fusion (TLIF) was originally described by Harms and Rollinger in the early 1980s as a surgical method of treating symptomatic lumbar disk degeneration. Objective: Evaluation of the clinical and radiological results of the instrumented Transforaminal lumber interbody fusion with single cage for the treatment of spondylolisthesis grade1 2 and in degenerative segmental instability. Patients and Methods: This is a prospective study of thirty patients with lumbar spondylolithesis either isthmic or degenerative, admitted and operated by transforaminal lumbar interbody fusion (TLIF) in the Department of Neurosurgery, Tanta University hospital, from January 2010 to July 2013. Results: In the thirty patients, 66.7% of them were females. Age of the patients ranged between 24-52 years with a mean age of 36 years. History of back trauma could be obtained in 40% of patients and incidence of consanguinity was 10% of patients. Low back pain and sciatica were present in all patients. Neurological deficits included sensory deficits in 40%, reflex changes in 40% and motor in 20% of patients. The affected level was L4-5 in 50%, L5-S1 in 40% and was L3-4 in 10% of patients. Grade I was encountered in 60%, and grade II in 40% of patients. All of the patients had good outcome as regard pain relief. The complications occurred in our study including wound infection in two patients, dural tear in two patients and TLIF cage migration with screw malposition in one patient. Clinical and radiological follow up of the patients was done for a period of 3-6 months. Solid fusion was obtained in 86.7%. Conclusion: The instrumented TLIF with single cage is a safe and effective method for the treatment of spondylolisthesis G I II and degenerative segmental instability.