Comparision of Spinopelvis Alignment with Short Segment Reduction and Fusion (Plif) In Low and High Grade Spondylolistesis

Abstract

Study Design: A prospective clinicoradiological study of PLIF was conducted in similar types and high grades > 2 spondylolisthesis in 40 patients, with 20 patients as controls with grade < 2. Objective: The objective was to assess the clinicoradiological profile of various spinopelvic parameters like pelvic incidence, pelvic version, sacrohorizontal angle, slip reduction and disc height increment using structural and standalone graft and its consequences on the post-operative outcome as assessed by Visual Analogue Score and Oswestry Disability Index. Methods: Before starting the study Institutional ethical committee approval was taken and approval no 654 was given for the study and prior consents were taken by all the patients included in the study and was documented. This study involved a total number of 40 patients of spondylolisthesis >2 and 20 patients of <2 of all the age groups with progressive neurological deficits, and pain not relieved by conservative measures. All patients underwent wide laminectomy, facetectomy, complete discectomy and posterior lumbar interbody fusion with intraoperative slip reduction maneuvers, disc height maintained with interbody stand-alone graft or structured grafts made of PEEK or Titanium cages. Conclusions: There was no correlation between duration of symptoms and post operative pain reduction. A fusion rates of 92% were achieved with intra operative slip reduction. The results obtained in comparison with slip reduction and post operative pain reduction are directly proportional and statistically not significant. A decrease in pelvic version and increase in sacrohorizontal angle were noted following surgery. Restoration and incrementing the disc height is associated with statistically significant pain relief. Polyetheretherketone (PEEK) inter body spacer has best clinical and radiological outcome in terms of maintenance of the disc height followed by titanium cage and stand alone graft respectively. All these results had significant positive predictive value in all cases of spondylolisthesis > 2 and was statistically insignificant in patients with grade <2.