European Spine Journal

, Volume 22, Issue 8, pp 1707–1713 | Cite as

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

  • N. A. QuraishiEmail author
  • Y. Raja Rampersaud
Grand Rounds



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.


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.


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°).


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.


High-grade spondylolisthesis Minimally invasive Spinal instrumentation 


Conflict of interest

Yoga Raja Rampersaud is a consultant for Medtronic.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Centre for Spine Studies and SurgeryQueens Medical CentreNottinghamUK
  2. 2.Divisions of Orthopedic and Neurosurgery, Krembil Neuroscience Center, Toronto Western HospitalUniversity of TorontoTorontoCanada

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