Lumbar Posterolateral Fusion With or Without Posterior Interbody Fusion in Degenerative Spondylolisthesis: Prognostic Factors and Clinical Outcome

Abstract Background: Spondylolisthesis primarily results from the gradual misalignment of vertebral bodies, particularly in the lumbar region. Degenerative and isthmic variants constitute approximately 90% of these vertebral displacements. This con-dition is prevalent in 20.7% of individuals aged 40 to 80 years, though only a subset of symptomatic patients necessitates sur-gical intervention. The preferred surgical approach for manag-ing degenerative spondylolisthesis (DS) continues to be con-tentious. Typically, a strategy involving decompression along with posterolateral fusion (PLF), optionally complemented by lumbar interbody fusion, is widely adopted. Aim of Study: This retrospective analysis was conducted to evaluate and contrast the outcomes between patients who un-derwent isolated PLF and those who received a combination of posterolateral fusion with interbody fusion (PLF + PLIF) for the management of degenerative spondylolisthesis. Patients and Methods: The study was conducted over a pe-riod of 36 months from August 2020 to August 2023 on 58 pa-tients having single level degenerative lumbar spondylolisthe-sis whom were operated in neurosurgery department in Banha University for decompression and posterolateral fusion with or without posterior interbody fusion. Results: While individuals undergoing PLF displayed a more pronounced postoperative recovery in conditions such as radiculopathy, bowel/bladder dysfunction, sensory anoma-lies, motor impairments, and back pain when compared to their counterparts receiving PLF + PLIF, these variations failed to reach a level of statistical significance. Nonetheless, the fre-quency of pseudoarthrosis/instrumentation failure and the ne-cessity for subsequent surgical interventions were significantly elevated within the PLF cohort. Radicular and neurological out-comes were statistically comparable between the two cohorts. Conclusion: In cases of low-grade degenerative spon-dylolisthesis, posterolateral fusion tends to yield superior clin-ical outcomes; however, posterior lumbar interbody fusion offers a more reliable approach for sustaining alignment correc-tion and achieving successful union. Thus, meticulous patient selection is critical for determining the appropriate surgical in-tervention.