Skip to main content
SpringerLink
Log in

Minimal access bilateral transforaminal lumbar interbody fusion for high-grade isthmic spondylolisthesis

  • Grand Rounds
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Minimally invasive or “minimal access surgery” (MAS) is being utilized with increasing frequency to reduce approach-related morbidity in the lumbar spine. This paper describes our minimal access technique for posterior bilateral transforaminal lumbar interbody fusion (TLIF) and spinal instrumentation in a patient with high-grade spondylolisthesis grade (Myerding Grade III) with 5-year follow-up.

Methods

A 24-year-old lady presented with mechanical back pain and left leg L5 radiculopathy. On examination, she was a thin lady with an obvious step deformity in the lower lumbar spine and otherwise, a normal neurological examination. Imaging showed a grade III isthmic L5–S1 spondylolisthesis with foraminal stenosis and focal kyphotic alignment of 20° [slip angle (SA) = 70°]. Conservative measures had failed, and a decision was made to proceed with a MAS-TLIF approach.

Results

The estimated blood loss was less than 100 ml, operating time 150 min, and post-operative hospital stay was 4 days. Post-operatively the patient had significant improvement of back and radicular pain. Improvement in ODI was substantial and sustained at 5 years. A solid fusion was achieved at 8 months. The slip percentage improved from 68 % (pre-op) to 28 % (post-op) and the focal alignment to 20° lordosis (SA = 110°).

Conclusions

A MAS approach for selected patients with a mobile high-grade spondylolisthesis is feasible, safe and clinically effective, with the added benefit of reduced soft-tissue disruption. Our result of this technique suggests that the ability to correct focal deformity, and achieve excellent radiographic and clinical outcome is similar to the open procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Boxall D, Bradford DS, Winter RB, Moe JH (1979) Management of severe spondylolisthesis in children and adolescents. J Bone Joint Surg 61A(4):479–495

    Google Scholar 

  2. Molinari RW (2002) Adult isthmic spondylolisthesis. Curr Opin Orthop 13(3):178–183

    Article  Google Scholar 

  3. Curylo LJ, Edwards C, DeWald RW (2002) Radiographic markers in spondyloptosis: implications for spondylolisthesis progression. Spine 27:2021–2025

    Article  PubMed  Google Scholar 

  4. Hanson DS, Bridwell KH, Rhee JM, Lenke LG (2002) Correlation of pelvic incidence with low- and high-grade isthmic spondylolisthesis. Spine 27:2026–2029

    Article  PubMed  Google Scholar 

  5. Molinari RW, Bridwell KH, Lenke LG et al (1999) Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches. Spine 24:1701–1711

    Article  PubMed  CAS  Google Scholar 

  6. Myerding HW (1932) Spondylolisthesis: surgical treatment and results. Surg Gynecol Obstet 54:371–377

    Google Scholar 

  7. Rampersaud YR, Gurgo RD (2008) Mini-open posterior lumbar interbody fusion for deformity. In: Mummaneni, Lenke, Haid (eds) Spinal deformity: a guide to surgical planning and management, Chap 35. Quality Medical Publishing, Inc., St. Louis, pp 721–748

  8. Schwender JD, Holly LT, Rouben DP, Foley KT (2005) Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech 18(Suppl):S1–S6

    Article  PubMed  Google Scholar 

  9. Ravi B, Zahrai A, Rampersaud R (2011) Clinical accuracy of computer-assisted two-dimensional fluoroscopy for the percutaneous placement of lumbosacral pedicle screws. Spine (Phila Pa 1976) 36(1):84–91

    Google Scholar 

  10. Rampersaud YR, Pik JH, Salonen D, Farooq S (2005) Clinical accuracy of fluoroscopic computer-assisted pedicle screw fixation: a CT analysis. Spine (Phila Pa 1976) 30(7):E183–E190

    Article  Google Scholar 

  11. Sears W (2005) Posterior lumbar interbody fusion for lytic spondylolisthesis: restoration of sagittal balance using insert-and-rotate interbody spacers. Spine J 5(2):161–169

    Article  PubMed  Google Scholar 

  12. Petraco DM, Spivak JM, Cappadona JG et al (1996) An anatomic evaluation of L5 nerve stretch in spondylolisthesis reduction. Spine 21:1133–1138

    Article  PubMed  CAS  Google Scholar 

  13. Cunningham BW, Lewis SJ, Long J et al (2002) Biomechanical evaluation of lumbosacral reconstruction techniques for spondylolisthesis: an in vitro porcine model. Spine 27:2321–2327

    Article  PubMed  Google Scholar 

  14. Jackson RP, McManus AC (1993) The iliac buttress. A computed tomographic study of sacral anatomy. Spine 18:1318–1328

    Article  PubMed  CAS  Google Scholar 

  15. Kuklo TR, Bridwell KH, Lewis SJ et al (2001) Minimum 2-year analysis of sacropelvic fixation and L5–S1 fusion using S1 and iliac screws. Spine 26:1976–1983

    Article  PubMed  CAS  Google Scholar 

  16. Lebwohl NH, Cunningham BW, Dmitriev A et al (2002) Biomechanical comparison of lumbosacral fixation techniques in a calf spine model. Spine 27:2312–2320

    Article  PubMed  Google Scholar 

  17. Mazda K, Khairouni A, Pennecot GF, Bloch J (1998) The ideal position of sacral transpedicular endplate screws in Jackson’s intrasacral fixation. An anatomic study of 50 sacral specimens. Spine 23:2123–2126

    Article  PubMed  CAS  Google Scholar 

  18. Minamide A, Akamaru T, Yoon ST et al (2003) Transdiscal L5–S1 screws for the fixation of isthmic spondylolisthesis: a biomechanical evaluation. J Spinal Disord Tech 16:144–149

    Article  PubMed  Google Scholar 

  19. Oppenheimer JH, DeCastro I, McDonnell DE (2009) Minimally invasive spine technology and minimally invasive spine surgery: a historical review. Neurosurg Focus 27(3):E9

    Article  PubMed  Google Scholar 

  20. Peng CW, Yue WM, Poh SY, Yeo W, Tan SB (2009) Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine (Phila Pa 1976) 34(13):1385–1389

    Article  Google Scholar 

  21. Kasis AG, Marshman LA, Krishna M, Bhatia CK (2009) Significantly improved outcomes with a less invasive posterior lumbar interbody fusion incorporating total facetectomy. Spine (Phila Pa 1976) 34(6):572–577

    Article  Google Scholar 

  22. Lamberg T, Remes V, Helenius I, Schenzka D, Seitsalo S, Poussa M (2007) Uninstrumented in situ fusion for high-grade childhood and adolescent isthmus spondylolisthesis: long-term outcome. J Bone Joint Surg Am 89(3):512–518

    Article  PubMed  Google Scholar 

  23. Glassman SD, Copay AG, Berven SH, Polly DW, Subach BR, Carreon LY (2008) Defining substantial clinical benefit following lumbar spine arthrodesis. J Bone Joint Surg Am 90(9):1839–1847

    Article  PubMed  Google Scholar 

  24. Shufflebarger HL, Geck MJ (2005) High grade isthmic dysplastic spondylolisthesis. Spine 30(6 Suppl):S42–S48

    Article  PubMed  Google Scholar 

  25. Rampersaud YR, Gray R, Lewis SJ, Massicotte EM, Fehlings MG (2011) Cost-utility analysis of posterior minimally invasive fusion compared with conventional open fusion for lumbar spondylolisthesis. SAS J 5:29–35

    Article  Google Scholar 

  26. Goyal N, Wimberley DW, Hyatt A, Zeiller S, Vaccaro AR, Hilibrand AS, Albert TJ (2009) Radiographic and clinical outcomes after instrumented reduction and transforaminal lumbar interbody fusion of mid and high-grade isthmic spondylolisthesis. J Spinal Disord Tech 22(5):321–327

    Article  PubMed  Google Scholar 

  27. Tsutsumimoto T, Shimogata M, Ohta H, Misawa H (2009) Mini-open versus conventional open posterior lumbar interbody fusion for the treatment of lumbar degenerative spondylolisthesis: comparison of paraspinal muscle damage and slip reduction. Spine (Phila Pa 1976) 34(18):1923–1928

    Article  Google Scholar 

  28. Kim KT, Lee SH, Suk KS, Bae SC (2006) The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine (Phila Pa 1976) 31(6):712–716

    Article  Google Scholar 

  29. Kim DY, Lee SH, Chung SK, Lee HY (2005) Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976) 30(1):123–129

    Article  Google Scholar 

Download references

Conflict of interest

Yoga Raja Rampersaud is a consultant for Medtronic.

Author information

Authors and Affiliations

  1. Centre for Spine Studies and Surgery, Queens Medical Centre, West Block, D Floor, Derby Road, Nottingham, NG7 2UH, UK

    N. A. Quraishi

  2. Divisions of Orthopedic and Neurosurgery, Krembil Neuroscience Center, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada

    Y. Raja Rampersaud

Authors
  1. N. A. Quraishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y. Raja Rampersaud
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. A. Quraishi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Quraishi, N.A., Rampersaud, Y.R. Minimal access bilateral transforaminal lumbar interbody fusion for high-grade isthmic spondylolisthesis. Eur Spine J 22, 1707–1713 (2013). https://doi.org/10.1007/s00586-012-2623-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-012-2623-2

Keywords

Search

Navigation