Comparative Study of Transpedicular Fixation with and without Interbody Fusion Cage in Management of L4-L5 Lumbar Degenerative Spondylolisthesis

Abstract

Background: Lumbar degenerative spondylolisthesis (LDS) is a clinically symptomatic degenerative slippage of a lumbar vertebra relative to the neighboring vertebra below. Objective: T h i s s t u d y a i m e d t o compare clinical and radiological outcomes following management of L4-L5 LDS with and without interbody fusion cage. Patients and methods: This prospective study included 40 patients with degenerative spondylolisthesis who were surgically treated by transpedicular screws with and without interbody fusion cage at the Neurosurgery Department, Faculty of Medicine, Menoufia University over a 3-year period from January 2018 to 21 January 2021.The patients were divided into two equal groups: Group A that involved patients treated by transpedicular screws only, and group B that included patients treated by transpedicular screws and inter body fusion cage. Results: Post-operative follow-up fusion was significantly higher among group B (17.01 ± 0.06) than a m o n g group A (15.01 ± 0.06) with a mean difference of 11.75% (p<0.001). On contrast, pseudoarthrosis and slip percentage were significantly increased among group A than among group B with a mean difference of 66.44% and 118%, respectively (p<0.001). VAS (low back pain and leg pain) significantly improved post-treatment compared to pretreatment among group A (p<0.001) where it was decreased from 8.01 ± 0.06 and 7.01 ± 0.06 to1.51 ± 0.06 and1.61 ± 0.06, with a mean change of 5.57 ± 2.31, (95%CI, 4.49-6.65); and 4.64 ± 1.88 (95%CI, 3.77-5.52) respectively, (p<0.001). Also, among group B, VAS (low back pain and leg pain) significantly improved post-treatment compared to pretreatment (p<0.001) where it was decreased from 7.01 ± 0.06 and 9.01 ± 0.06 to 2.01 ± 0.06 and 2.41 ± 0.06 respectively with a mean change of 4.84 ± 1.14 (95% CI, 4.32-5.36), and 6.21 ± 1.55 (95% CI, 5.50-6.91) respectively (p<0.001). Conclusion: Transpedicular fixation by screws with and without interbody fusion produces the same outcomes in terms of postoperative clinical improvement and patient satisfaction.