Clinical and Radiological Outcomes of Monosegmental Minimally Invasive Transforaminal Lumbar Interbody Fusion for...

High-grade isthmic spondylolisthesis remains surgically controversial, and evidence on minimally invasive, single-level reduction and fusion with mid-term follow-up remains limited. This study aimed to investigate the efficacy and safety of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and percutaneous pedicle screw fixation for high-grade (Meyerding Grade III) spondylolisthesis.

This prospective observational case series included 14 consecutive patients with Meyerding Grade III isthmic spondylolisthesis treated at a single institution between 2014 and 2019. All patients underwent monosegmental MIS-TLIF with percutaneous pedicle screw fixation. Outcome measures included VAS (back and leg pain), ODI, slip percentage, Dubousset lumbosacral angle, and other spinopelvic parameters. Pre- and postoperative comparisons were performed using paired t-tests (p < 0.05).

Fourteen patients had a mean age of 54.9 years with a diagnosis of isthmic spondylolisthesis, Meyerding Grade III. The average estimated blood loss was 273.93 mL (range, 197-380 mL). The average operating time was 142.14 min (range, 125-165 min). The average follow-up duration was 43.5 months, with a range of 38-60 months. In most cases, radicular pain was significantly relieved postoperatively. The mean ODI scores decreased from preoperative 65.56% to postoperative 7.93%. All cases achieved near-anatomic reduction, and lumbosacral lordosis was significantly corrected. The average slip percentage improved from 64.36% (preop) to 5.88% (postop), and the average Dubousset-LSA increased from 81.96° (preop) to 105.93° (postop). The overall sagittal profile improved dramatically.

MIS-TLIF and percutaneous pedicle screw fixation may offer a safe and effective treatment option for high-grade spondylolisthesis, with satisfactory clinical and radiological outcomes.