Upright MRI Follow-Up for Decompression and Interlaminar Stabilization in Low-Grade L4/L5 Spondylolisthesis Suggests...

Area of Science:

• Orthopedic Surgery
• Spinal Biomechanics
• Radiology

Background:

• Spinal fusion is standard for symptomatic low-grade spondylolisthesis.
• Evidence for motion-preserving alternatives like decompression with interlaminar stabilization (D+ILS) is limited.
• Upright MRI can assess dynamic spinal mechanics under physiological load.

Purpose of the Study:

• To descriptively evaluate clinical and radiological outcomes of D+ILS at L4/L5.
• To assess dynamic spinal stability using upright MRI post-D+ILS.
• To investigate D+ILS in a strictly selected cohort with L4/L5 spondylolisthesis.

Main Methods:

• Prospective observational study of 30 patients with degenerative low-grade spondylolisthesis at L4/L5.
• Treatment involved D+ILS using the Coflex interlaminar stabilization device.
• Outcomes assessed via functional upright MRI and validated questionnaires, with strict inclusion criteria.

Main Results:

• Mid-term follow-up (43 months) showed preserved segmental alignment and reduced stenosis on upright MRI.
• Patients experienced significant improvements in pain, function, and ambulation.
• Radiological progression of osteoarthritis and disc degeneration was mild; one reoperation for adjacent segment degeneration.

Conclusions:

• D+ILS may be a feasible motion-preserving treatment for carefully selected L4/L5 spondylolisthesis patients.
• This is the first study to use upright MRI for postoperative mechanics assessment in a D+ILS cohort.
• Findings are descriptive and hypothesis-generating, requiring confirmation in controlled trials.