Mini posterior lumbar interbody fusion with presacral screw stabilization in early lumbosacral instability

Surgical options for the management of early lumbosacral spondylolisthesis and degenerative disc disease with instability vary from open lumbar interbody fusion with transpedicular fixation to a variety of minimal access fusion and fixation procedures. We have used a combination of micro discectomy and axial lumbosacral interbody fusion with presacral screw fixation to treat symptomatic patients with lumbosacral spondylolisthesis or lumbosacral degenerative disc disease, which needed surgical stabilization. This study describes the above technique along with analysis of results.

Twelve patients with symptomatic lumbosacral (L5-S1) instability and degenerative lumbosacral disc disease were treated by micro discectomy and interbody fusion using presacral screw stabilization. Patients with history of bowel, bladder dysfunction and local anorectal diseases were excluded from this study. Postoperatively all patients were evaluated neurologically and radiologically for screw position, fusion and stability. Oswestry disability index was used to evaluate results.

We had nine females and three males with a mean age of 47.33 years (range 26-68 years). Postoperative assessment revealed three patients to have screw placed in anterior 1/4(th) of the 1(st) sacral body, in rest nine the screws were placed in the posterior 3/4(th) of sacral body. At 2 years followup, eight patients (67%) showed evidence of bridging trabeculae at bone graft site and none of the patients showed evidence of instability or implant failure.

Presacral screw fixation along with micro discectomy is an effective procedure to manage early symptomatic lumbosacral spondylolisthesis and degenerative disc disease with instability.