Clinical and Radiological Outcome of Pedicular Transvertebral Screw Fixation of the Lumbosacral Spine in Spondylolisthesis vs. Unilateral Transforaminal Lumbar Interbody Fusion (TLIF) with Harms Cages

Material and Methods: Forty patients divided in two groups A, TILIF 360 fusion, B transacral screws. The average age at the time of surgery was 33 years (range, 19-48 years), and the average follow-up period was 35 months (range, 24-48 months). Before surgery, twenty patients had low back pain, ten patients had radiating leg pain, and ten patients had hamstring tightness. The average grade of spondylolisthesis by Meyerding grading was 3.6 (range, 3-5). An SRS outcome score was also obtained on all patients to evaluate postoperative outcome, in terms of pain control, self-image perception, and return to function.

Results: Group A.100% fusion, (based on oblique radiographs showing lateral bridging bone masses and a CT). The slip angle, as measured from the inferior end plate of L5, improved from 38.6 (range, 24 -78 ) before surgery to 23.8 (range, 12-38 ) after surgery. Group B 19 patients evidenced solid fusion by the 6-month follow-up. The slip angle, improved from 38.2 (range, 22-78 ) before surgery to 23 (range, 9-36 ) after surgery there was no significant improvement in the percentage slip or the sacral inclination in any of the groups. Complications A: seven incidental durotomies and three infections B: one dural tear, one pseudoarthrosis, two superficial infections one broken transvertebral screw. There were no neurologic complications in any of the groups The SRS outcome instrument demonstrated good postoperative pain control, function, self-image, and satisfaction in both groups.

Conclusions: No differences in radiological and clinical outcome were found, so both are useful in spondylolisthesis treatment. The only differences were that the higher the grade the difficulty of the technique increases in the TILIF group and decreases in the Transacral group.