Multiple-Level Low-Grade Lumbar Spondylolisthesis: Instrumented Posterolateral Fusion Using a Local Bone Graft

Background Data: Lumbar spondylolisthesis is a major cause of back pain. It occurs most commonly at only one spinal level. Multiple-level lumbar spondylolisthesis is uncommon, with few reports available in the literature. It can be treated by instrumented posterolateral fusion (PLF) using iliac crest bone graft (ICBG) with possible reported donor site complications. A reasonable alternative is local bone graft obtained from the laminae and spinous processes harvested during neural decompression. Purpose: To evaluate the outcome of multiple-level spondylolisthesis treated by PLF using a local bone graft. Study Design: Prospective clinical case series. Patients and Methods: Eleven patients (6 males and 5 females) with mean age 48.18 ± 9.7 years with multiple-level lumbar spondylolisthesis who underwent PLF using local bone graft in our University Hospital between 2015 and 2017 were evaluated. The mean duration of low back pain (LBP) was 11.36 ± 1.8 (range, 9–14) months. Operation time and blood loss were recorded. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), while fusion was evaluated using the Lenke classification for posterolateral fusion. Results: The mean operative time was 87.7 ± 19.1 minutes, while blood loss was 541.8 ± 135.5 ml, and the mean follow-up period was 34.55 ± 3.2 months. VAS and ODI improved significantly from preoperatively to postoperatively and at last follow-up (p < 0.05) with no significant difference in terms of gender or age. Radiologically, solid bone fusion was achieved in 23 out of 27 operated levels (85%). One screw was broken, and two patients had superficial wound infections. Conclusion: Our data suggest that instrumented PLF using local bone graft can effectively be used to manage multiple-level lumbar spondylolisthesis with satisfactory outcome and avoid ICBG donor site morbidity. (2020ESJ222)