Posterior Lumbar Element Enforcement by Decompression Alone with Interspinous Fixation without Interbody Fusion for the Surgical Management of Lumbar Spondylolisthesis

Objective : In degenerative lumbar spondylolisthesis, interbody fusion surgery (IFS) has long been recommended as the gold standard of surgical management. However, IFS is less recommended for high-risk patients such as the elderly because it involves extensive surgery, with a long operation time and high volumes of blood loss, which lead to marked perioperative morbidity. We report an alternative primary and salvage treatment technique for high-risk lumbar spondylolisthesis through posterior lumbar element reinforcement using interspinous fixation and decompression alone without interbodyfusion. Methods : Plain radiographs, computed tomography scans, and magnetic resonance imaging, taken at different intervals, were used to measure local disc height (DH), vertebral body slippage (BS), and segmental motion angle (SMA). A Visual analogue scale and the Oswestry disability index (ODI) were applied pre-operation and at the last follow-up. Results : The local SMA decreased significantly by 3.46 degrees +/- 3.07 degrees, from 10.61 degrees +/- 3.42 degrees preoperatively to 7.15 +/- 3.70 at the last follow-up (p<0.001). The DH decreased from 8.61 +/- 2.88 mm preoperatively to 8.41 +/- 2.48 mm at the last follow-up (p=0.074). The BS decreased from 3.49 +/- 4.29 mm preoperatively to 3.41 +/- 4.91 mm at the last follow-up (p=0.092). None of the patients reported worsening pain or an increased ODI after surgery, and there were no surgery-related complications. Conclusion : Posterior lumbar element reinforcement by decompression alone with SPIRETM fixation is an alternative primary and salvage treatment option for select patients with spondylolisthesis.