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Dynamic versus Fixed Lumbar Spondylolisthesis: Clinical, Radiographic, and Functional Outcomes Following

Barón Zárate-Kalfópulos1, Fernando Pesantez-Mochas1, Patricia Rojo-Castillo2

  • 1Spine Surgery Division, National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.

World Neurosurgery
|July 20, 2025
PubMed
Summary

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A 2.45 mm displacement threshold effectively distinguishes dynamic from fixed lumbar spondylolisthesis (LS). While dynamic LS shows higher reduction loss after transforaminal lumbar interbody fusion (TLIF), both types achieve similar patient outcomes.

Area of Science:

  • Spine surgery
  • Orthopedics
  • Radiology

Background:

  • Lumbar spondylolisthesis (LS) involves vertebral displacement, categorized as dynamic (mobile) or fixed.
  • Dynamic LS may influence surgical outcomes, necessitating differentiation for optimal treatment.
  • Understanding these subtypes is crucial for surgical planning in degenerative LS.

Purpose of the Study:

  • To compare clinical and radiographic differences between dynamic and fixed LS in patients undergoing transforaminal lumbar interbody fusion (TLIF).
  • To establish an optimal displacement threshold for defining dynamic instability in LS.
  • To evaluate the impact of LS subtype on TLIF outcomes.

Main Methods:

  • Retrospective cohort study of 76 patients with degenerative low-grade LS treated with TLIF.
Keywords:
Degenerative spondylolisthesisInterbody fusionSpinal fusionSpinal instabilitySpondylolisthesisTransforaminal lumbar interbody fusion (TLIF)

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  • Classification of dynamic vs. fixed LS using receiver operating characteristic (ROC) curve analysis for displacement.
  • Assessment of clinical outcomes (ODI, VAS, SF-36) and radiographic parameters over 24 months postoperatively.

    • Main Results:

    • A displacement threshold of 2.45 mm was identified with high sensitivity (95.5%) and specificity (97.1%) to differentiate dynamic LS.
    • Dynamic LS (63.4% of cases) showed higher preoperative listhesis and greater postoperative reduction loss.
    • Despite radiographic differences, patient-reported outcomes improved similarly in both dynamic and fixed LS groups post-TLIF.

    Conclusions:

    • The 2.45 mm threshold aids in distinguishing dynamic from fixed LS, potentially guiding surgical decisions.
    • Transforaminal lumbar interbody fusion (TLIF) yields comparable functional results for both dynamic and fixed LS subtypes.
    • Further prospective research is recommended to validate findings and refine surgical strategies for LS.